Parenteral Nutrients and Formulations


BOX 3.5 Advantages and Disadvantages of 3-in-1 Solutions (Total Nutrient Admixtures)8,24


Advantages All components are aseptically compounded by the pharmacy


Preparation is more efficient for pharmacy personnel, especially if automated Less manipulation of the system is needed during administration


Inhibited or slower bacterial growth if contamination does occur compared with separate intravenous lipid emulsion (ILEs) (though note there is no clinical difference in infectious complications between 2-in-1 and 3-in-1 formulations)


Less nursing time needed for 1 container per day and no piggyback ILE to administer


Less supply and equipment expense for only 1 infusion pump and IV tubing


More convenient storage, fewer supplies, and easier administration in home-care settings


Dextrose and venous access tolerance may be better in some situations


Possible applications in patients with fluid restrictions because ILE 30% is restricted to use in 3-in-1 formulations More cost-effective overall in certain settings


Fat clearance may be better when ILE is administered over more than 12 hours


Disadvantages Admixed ILE is less stable, more prone to separation of lipid components


Formulations are more sensitive to destabilization with certain electrolyte concentrations


Formulations are more sensitive to destabilization with low concentrations of dextrose, amino acids, and ILE


Lower pH amino acid formulations may destabilize the ILE portion of the admixture


Box continues


47


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