title: Practical aspects of multichamber bags for total parenteral nutrition.
abstract: OBJECTIVE
  Ready-to-use all-in-one admixtures are standards for short and long-term parenteral nutrition. Their limited stability does not allow storage over prolonged periods of time. Multichamber bags represent industrially manufactured near complete standard parenteral nutrition premixes with extended shelf lives. This review focuses on the characterization of multichamber bags, their influence on parenteral nutrition practice, the need for individual parenteral nutrition compounding, and the role of the pharmacist in the nutrition team.
  
  
  RESULTS
  The all-in-one admixture concept, its correlation with parenteral nutrition effectiveness, safety, and pharmaceutical issues are reviewed. Multichamber bags, the bag material, their use and practical handling are addressed.
  
  
  CONCLUSIONS
  Newly developed container materials are mainly responsible for the increased stability of multichamber bag parenteral nutrition premixes. Multichamber bags are used for (standard) parenteral nutrition in adults. Multichamber bags cannot eliminate individualized all-in-one parenteral nutrition compounding. Pharmaceutical assistance with expertise in compatibility and stability is mandatory for the nutrition team to implement and control good parenteral nutrition practices, e.g. to convert multichamber bags into complete ready-to-use all-in-one admixtures or to compound individualized regimens. The incorporation of additional components into parenteral nutrition admixtures (pharmaconutrients, drugs) must rely on documented compatibility with the parenteral nutrition admixtures. Multichamber bags have their advantages and limitations. Studies on the effectiveness and costs of multichamber bags are needed to meet the expectations of pharmacists, physicians, nurses, and industry for optimal parenteral nutrition in patients.
authors.affiliation: Swiss Agency for Therapeutic Products, Berne, Switzerland. stefan.muehlebach@swissmedic.ch
authors.forename: Stefan
authors.initials: S
authors.lastname: Mühlebach
mesh_terms: D004339:Drug Compounding; D004349:Drug Packaging; D004355:Drug Stability; D004356:Drug Storage; D006801:Humans; D010289:Parenteral Nutrition, Total / Q000295:instrumentation* / Q000379:methods / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000592:standards*; D012449:Safety; D013997:Time Factors
chemical_list: D004364:Pharmaceutical Preparations