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PhilSPEN Online Journal of Parenteral and Enteral Nutrition

(Article 141 | POJ_0133 | 2018-2019)

Original Clinical Investigation

Clinical Nutrition Service Report: parenteral nutrition utilization in St. Luke's Medical Center, Quezon City from May 2016 to June 2017

Abstract | Introduction | Methodology | Results | Discussion | Conclusion | References | Back to Total Name and Codes page2

Submitted: | Posted:

Authors:

Clinical Nutrition Service, St. Luke's Medical Center, Quezon City, Philippines

Institution where research was conducted

Clinical Nutrition Service, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, Metro-Manila, Philippines

 

ABSTRACT: | Back

Background:

There was an increase in the number of parenteral nutrition available to the market from March 2016 to June 2017. Due to these increase there was a need again to evaluate the composition and results of these products especially on the effectivity and lack of side effects.

Objective:

All parenteral nutrition products were evaluated in terms of both composition and effectvity of their components. The duration of effect including includes their non-variablity of effectiveness throughout their placement in the vein, their storage life, and the absence of sequelae post-placement. The presence of side effects were also monitored.

Methodology:

For one year the products were analyzed in both storage and actual use for the patients. All of the effects from actual instillation and effects of the products all throghout duration of stay from the veins to the post-instillation were evaluated.

Results:

These were measured: the total stay of the products per instillation like the mean projected and actual calories and protein per kg/day; the number of components per instillation (whether it is in one or more combination); whether these were one placement or more; and whether any vitamin or trace elements were present or others component combination like soft emulsion (lipids).

Conclusion:

All types of parenteral nutrition combinations were evaluated (n=677 products) and there were minimal side effects noted in all these products.

 

KEYWORDS: Parenteral nutrition, calorie and protein requirements per day

 

INTRODUCTION | Back

The May 2016 to June 2017 showed an increased utilization of parenteral nutrition. It also marked an increasing number of available products from other companies which would show an interest as well as driving down of the market due to its wider areas of choice. Hence an increase again of the safety protocols were implemented due to the wide array of available products. These are the experiences gathered as the market increased in both volume and utilization.

METHODOLOGY | Back

667 records from May 2016 to June 2017 of all uses of parenteral nutrition implementation

All parenteral solutions have the following contents:

  • All in one combinations (three compartments of carbohydrates, protein and fat solutions)
  • Two compartments (two compartments of carbohydrates and protein solutions)
  • Vitamins (single combitnations)
  • Trace elements

These are all delivered using the different conbinations either as single or in combinations.

 

RESULTS | Back

Analysis of PN utilization: CNS, SLMC-QC

Calories:

  • Mean computed calorie requirement/day = 1,533 kcal (sd=248)
  • Mean actual calories delivered/day = 1,107 kcal/day
  • Mean actual calorie percent intake/day = 72.4% (sd=28.8)

Protein

  • Mean computed protein requirement/day = 72.5 gm/day (sd=15.7)
  • Mean actual protein delivered/day = 48.33 gm/day
  • Mean actual protein percent intake/day = 68% (sd=30.3)

Type of parenteral nutrition given (Nutrition source: PN = 36%; EN = 64%)

  • "Three in one bags" = 147/667 (22%)
  • Single protein solution = 16/667 (2%)
  • Intravenous dextrose = 80/667 (12%)
  • All had vitamin and trace element incorporated daily

Pareenteral nutrition component profile:

  • Mean calories from PN alone = 703.4 kcal/day (sd=386.05)
  • Mean percent calories from PN alone = 66.8% (sd=29.44)
  • Mean protein from PN alone = 33 gm/day (sd=17.19)
  • Mean percent protein from PN alone = 72.9% (sd=28.8)

CNS = Clinical Nutrition Service; SLMC-QC: St. Luke’s Medical Center – Quezon City

 

DISCUSSION: | Back

From the three in one bags which makes up 22% of total parenteral nutrition, to the intravenous dextrose which practically has pure dextrose (12%), to the single protein solution (2%) all contributed to the total mixture of calories and protein. These had vitamins and trace elemtns mixed daily per injection of the total solution given daily.

Of the total number of calories given to the patients, a mean value of 1,100 kcal//day was delivered by the parenteral route. It more or less gave an adequate dose per patients specially if they had either an enteral dose of a minimum of 500 kcal/day. By calculations if the total percentage of calories were given it almost reached the total dose of required calories without any additional enteral nutrition. Thus a 70% total parenteral calories was delivered per day which more or less would be the daily requirement of the patientss.

The computed percent of protein intake was around 72% per day however, the actual protein delivered was around 48 gm/day which is lower compared to the expected. Thus protein still needs to be raised to near 70% in order to fulfill the requirement. At the moment the 68% percent protein still needs a little rising up to more or less the 70% level. It is a good thing the patients had an additional 64% of enteral nutrition that was able to fill up the gap.

If we analyze the mean calories from parenteral nutrition alone there is a total of 703.4 calories/day and ading to it the standard deviation of 386.05 it more or less fulfills the basice needs of the patient which is at 68% of calories. Now the mean protein of 33 gm/day from parenteral nutrition makes up around 72% which is more or less alright to these patients.


CONCLUSION: | Back

The infusion of total parenteral nutrition makes the overall nutrient requirement adequate from 1,100 kcal/day to 48 gm/day in this report of the total parenteral nutrition usage.

 

REFERENCES: | Back

  1. Llido LO, Sioson M, Inciong JF, and Manuales G. Nutrition team supervision on nutrient intake in critical care patients: report of a ten year experience in the Philippines (years 2000 to 2011). Philippine Online Journal of Parenteral and Enteral Nutrition. Article 2; POJ-0007; Jan 2010-2012: 9-16 pages.
  2. Llido LO, Parenteral nutrition practice from years 1994 to 1996 in St. Luke's Medical Center. A locel study - unpublished (1997).
  3. Llido LO. Nutrition support team: impact on parenteral nutrition implementation practice, 2004. Local study - unpublished (2004)
  4. Clinical Nutrition Service Report: parenteral nutrition utilization in SLMC, QC from May 2016 to June 2017. Philippine Online Journal of Parenteral and Enteral Nutrition. Art _; POJ_0133; _2018-19: _ pages.
  5. Calamba PJ MD and Llido LO MD. Critical care nutrition update: does the nutrition team still achieve adequate intake? Philippines Online Abstract of Parenteral and Enteral Nutrition. Abstract ID (81). PENSA 2017 Congress.
  6. Wischmeyer et al. A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Critical Care 2017; 21: 142 pages.
  7. The Unrisk Study Group, Philippine Society of Parenteral and Enteral Nutrition. The Undernutrition Risk and Underfeeding Status among in-patients and out-patients n hospital in the Philippines ("The Unrisk Study"), Art 28; POJ_0022; Issue Jan 2016 - June 2016: 121-133 pages.

 

Abstract | Introduction | Methodology | Results | Discussion | References | Back to Total Name and Codes page2