Practical considerations regarding the use of total nutrient admixtures.
The biological concerns, proper storage and administration, and advantages of using total nutrient admixtures (TNAs) for nutritional support are reviewed. In 1983, FDA approved lipid emulsions for administration with dextrose and selected crystalline amino acid preparations (known as three-in-one or total nutrient admixtures). The stability of TNAs is affected by pH, order of mixing, and temperature. Conflicting results have been reported on the issue of microbial growth potential in TNAs. At room temperature, the delivery of the TNA infusate should not exceed 24 hours. Plastic containers that do not contain diethylhexyl phthalate, in sizes up to 3 L, are practical and safe for administration of TNAs. The efficiency of an institution's volumetric pumps should be evaluated before converting to a TNA system because the low final concentrations of lipid emulsion present in the admixtures may render certain pumps inoperable. The practical, nutritional, and potential economic benefits of a TNA delivery system support its use. Further research is needed to determine microbial growth potential, electrolyte and drug compatibilities, and stability under prolonged storage of these admixtures.
Driscoll
D F
DF
Baptista
R J
RJ
Bistrian
B R
BR
Blackburn
G L
GL
D004339:Drug Compounding; D004340:Drug Contamination; D004356:Drug Storage; D005217:Fat Emulsions, Intravenous; D006801:Humans; D010289:Parenteral Nutrition, Total
D005217:Fat Emulsions, Intravenous