Rationality Evaluation Of 1533 Prescription About Total Parenteral Nutrient Solution And Stability Test Of Typical Nutrient Solution

Objective: It is to evaluate the rationability of Total Parenteral Nutrient(TPN)prescription provided for inpatients of one hospital in 2015,and provide reference for reasonable use of TPN.According to the results of TPN prescription comments,experiment is designed to investigate the adsorption of insulin onto PVC infusion bag and the stability of typical TPN solutions,which can provide some experimental basis for better application of TPN.Methods: A retrospective survey was conducted on 1533 TPN prescriptions for the inpatients in 2015.Patients' basic information(gender,age,weight,diagnosis result,nutritional status,etc.)and the applied TPN information(drug type,dosage and medication days)were recorded and analyzed.A comprehensive analysis of TPN prescriptions was carried out on the ratio of glycolipid,ratio of heat to nitrogen,liquid volume,nutrient composition,electrolyte concentration and medication days,et al.As same as actual condition,insulin was mixed with glucose injection,sodium chloride injection or TPN solution in a polyvinyl chloride(PVC)infusion bag respectively.The concentration of insulin was determined by HPLC at different time points(0,2,4,6,8,10 h)and the adsorption ratio of insulin to the PVC bag was calculated.Four typical TPN prescriptions were selected and prepared according to standard operation practice.The osmotic pressure,pH value and particle size of the fat emulsion in TPN at different time points(0,12,24h)were determined to evaluate the stability of nutrient solution.Results: TPN were mainly used in departments of general surgery,gastroenterology,oncology in the studied hospital.The main indication population were elder patients.The composition and clinical application of TPN were basically reasonable,but individualized dosage regimen inaccordance with the actual situation of the patient is few.There are still some prescriptions of TPN unqualified at the index of the ratio of glycolipid,ratio of heat to nitrogen,liquid volume,nutrient composition,electrolyte concentration and medication days,et al.To keep good blood glucose level,65.6 percent of TPN solutions were added insulin.In the absorbability study of insulin to PVC bag,we found the concentration of insulin in PVC bag filled with different infusion solutions did not change significantly during 12 h.The adsorption rate of insulin was less than 5% for glucose or sodium chloride solution,and less than 6% for TPN solution.These results are very different from these reported in literature.In four TPN solutions with different compositions,pH values were among 5.7 to5.9,the osmotic pressures were within the range of 900-1100 mOsm/L.When added in different electrolytes,fat emulsion particle size in the TPN solutions had a tendency to increase with the extension of the time,but they were all less than 250 nm within 24 hours,which indicated the nutrient solution was stable,and suitable for clinical application.Conclusions:1 The use of TPN is basically reasonable and in accordance with the specification.The pharmacist should continue to pay attention to the check of sugar-lipid ratio,heat nitrogen ratio,medication time,etc.At the same time,individualized dosage regimen should be made according to patient's specific situation.2 PVC bag can adsorb some insulin but the degree of adsorption is significantly lower than previous reports,the content changes of insulin in TPN is thought to have no influence on the blood glucose and the infusion method of insulin added in TPN is safe,convenient and effective.3 Osmotic pressure,pH value and fat emulsion particle size of the selected four TPN solutions most used are all in the acceptable range of body,and have good stability,so they can be used safely in clinical.This study provides experimental basis for the rational use of TPN.