• Mirtallo J, Canada T, Johnson D, Kumpf V, Petersen C, Sacks G, Seres D, Guenter P, Task Force for the Revision of Safe Practices for Parenteral Nutrition. Parenteral nutrition administration. In: Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr 2004 Nov-Dec;28(6):S65-70. [32 references]

This is the current release of the guideline.

1. Central parenteral nutrition (PN) is administered via a central venous access catheter (CVC) with the distal tip placed in the superior vena cava adjacent to the right atrium.
2. The use of femoral catheters for PN administration should be avoided.
3. Proper CVC tip placement shall be confirmed prior to initial PN administration and/or any other time signs/symptoms indicate an improper catheter position. Proper CVC tip placement shall also be confirmed/validated in the pediatric patient when there has been significant growth.
4. Care and maintain venous catheters used for PN according to published standards.
5. Equipment used to administer PN formulations shall be selected based on the safest mode of delivery for both the patient and the healthcare provider.
6. A 1.2 micron filter may be used for all PN formulations. Alternatively a 0.22 micron filter may be used for 2-in-1 formulations.
7. A filter that clogs during PN infusion may be indicative of a problem and may be replaced but shall never be removed.
8. PN final containers and administration sets shall be free of the plasticizer, di (2-ethylhexyl) phthalate if intravenous fat emulsion (IVFE) is a component of the nutrient regimen.
9. Administration sets for IVFE infusions separate from PN formulations shall be discarded after use or if the IVFE is infused continuously, at least every 24 hours.
10. Administration sets for total nutrient admixture (TNA) are changed every 24 hours.
11. Administration sets for 2-in-1 formulations are changed every 72 hours.
12. PN is to be administered via an infusion pump having adequate protection from 'free flow' and reliable, audible alarms.
13. Medical devices for PN administration should be used that minimize risk of needle-stick injuries and exposure to blood-borne pathogens.
14. Prior to PN administration, the patient's identity is verified and the PN label is reviewed for accuracy and expiration dates.
15. Visually inspect each PN prior to administration, do not infuse the PN formulation if visual changes or precipitates are apparent.
16. The PN infusion shall be completed within 24 hours of initiating the infusion.
17. IVFE infused separately from PN formulations shall be completed within 12 hours of entry into the original container.
18. The patient receiving PN should be monitored to determine the efficacy of the PN therapy; detect and prevent complications; evaluate changes in clinical conditions; and document clinical outcomes.
19. A policy and procedure should be in place to deal with the use of PN formulations prepared by an outside facility.

None provided

The recommendations are supported by a review of the literature as well as results from the 2003 American Society for Parenteral and Enteral Nutrition Survey.

• Mirtallo J, Canada T, Johnson D, Kumpf V, Petersen C, Sacks G, Seres D, Guenter P, Task Force for the Revision of Safe Practices for Parenteral Nutrition. Parenteral nutrition administration. In: Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr 2004 Nov-Dec;28(6):S65-70. [32 references]

Not applicable: The guideline was not adapted from another source.

2004 Dec

American Society for Parenteral and Enteral Nutrition - Professional Association

American Society for Parenteral and Enteral Nutrition

Task Force for the Revision of Safe Practices for Parenteral Nutrition

Task Force Members: Jay Mirtallo, MS, RPh, BCNSP, Chair; Todd Canada, PharmD, BCNSP; Deborah Johnson, MS, RN; Vanessa Kumpf, PharmD, BCNSP; Craig Petersen, RD, CNSD; Gordon Sacks, PharmD, BCNSP; David Seres, MD, CNSP; Peggi Guenter, PhD, RN, CNSN

Not stated

This is the current release of the guideline.

This NGC summary was completed by ECRI Institute on July 8, 2008. The information was verified by the guideline developer on July 30, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Reprint request/permissions should be sent to: Permissions Department, ASPEN; 8630 Fenton St. #412; Silver Spring, MD 20910; Fax: 301-587-2365.