title: Maximum tolerated osmolarity for peripheral administration of parenteral nutrition in pediatric patients.
abstract: BACKGROUND
  Limited data support a recommended maximum osmolarity for administration of peripheral parenteral nutrition (PPN). In this retrospective, matched-cohort study, we evaluated the incidence of phlebitis or infiltration associated with administration of PPN with an osmolarity >1000 mOsm/L vs ≤1000 mOsm/L.
  
  
  METHODS
  Patients ≤18 years old who received PPN in a 2-year period were included in the study. Data related to patient demographics, PPN constituents, and adverse effects were analyzed.
  
  
  RESULTS
  A total of 352 patients met entry criteria. Overall, 139 (40%) patients experienced phlebitis or infiltration. There were no differences between patients who did or did not develop adverse events in terms of age or weight. Administration of PPN with osmolarity >1000 mOsm/L vs ≤1000 mOsm/L significantly increased infiltration (17% vs 7%; odds ratio [OR, 2.47]; 95% confidence interval [CI], 1.24-4.94; P = .01) and the combined composite end point of phlebitis or infiltration (45% vs 34%; OR, 1.65; 95% CI, 1.07-2.54; P = .02). In multivariate analysis, osmolarity >1000 mOsm/L vs ≤1000 mOsm/L was an independent risk factor for developing complications (OR, 1.67; 95% CI, 1.08-2.52; P = .02).
  
  
  CONCLUSIONS
  Two of every 5 children experienced phlebitis or infiltration during administration of PPN. These adverse effects were more often observed in those who received PPN with osmolarity >1000 mOsm/L vs ≤1000 mOsm/L. With this high incidence of adverse effects, we recommend that if PPN is used, the osmolarity should not exceed 1000 mOsm/L. More important, PPN should only be used temporarily until central access is obtained.
authors.affiliation: Children's Hospital of Orange County, Orange, California sdugan@choc.org.
authors.forename: Shannon
authors.initials: S
authors.lastname: Dugan
authors.affiliation: UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Le
authors.affiliation: Children's Hospital of Orange County, Orange, California.
authors.forename: Rita K
authors.initials: RK
authors.lastname: Jew
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009994:Osmolar Concentration; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D010689:Phlebitis / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D057947:Parenteral Nutrition Solutions
keywords: adverse effects; children infants; infiltration; neonates; osmolarity; pediatric; peripheral parenteral nutrition (PPN); phlebitis