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Parenteral Nutrition Compounding
Parenteral nutrition regimens are complex medications. They consist of many macro- and micronutrients in various combinations and range in volume from 100 ml for preterm infants and neonates to 4,000 ml for adults.
They can be available as patient-specific formulation in ready-to use preparations – based on single nutrients or modified commercially available 2-chamber bags or 3-chamber bags – e.g., for neonates and preterm infants where requirements might change daily, for patients with hepatic or renal insufficiency or short bowel patients. These patient-tailored regimens can either be prepared manually or automatically with a compounding device.
Manual compounding of pharmaceuticals is a routine task for pharmacists, where precision and accuracy are key to avoiding risks and providing safe nutritional solutions and medications. To support you in your daily work in a compounding pharmacy, we offer a broad range of compounding bags with different features. Still, manual compounding can be a labor-intensive and time-consuming process. For many preparations per day automated compounding can be a solution for your workflow. For all applications where there is less to compound, B. Braun's Nutrimix bags offer the needed flexibiliy in parenteral nutrition compounding.
To support compatibility for the parenteral solution, B. Braun provides easy to mix multi-chamber bags, supplements, and compatibility tools.
Parenteral nutrition (PN) regimens are complex medications containing many macro- and micronutrients in various volume combinations ranging from 100 ml - 4,000 ml for children and adults. They are available as ready-to-use formulas or patient-specific preparations, e.g., for oncology patients or patients with renal or hepatic insufficiency and they can be prepared either manually or automatically with a compounding device.
Especially for premature and newborn infants, the requirements might be adjusted daily, making precise work absolutely essential to avoid dosing errors – the most common medication error in children.1, 2 Accurate delivery is one of the main advantages of automated compounding devices compared to manual preparation.
In addition to accuracy, time is also an important factor, as many hospital pharmacists must prepare 25, 30, or more bags each day. With manual compounding, this task is even more time-consuming than with the help of an automated compounding device.
APEX® is an automated compounding device (ACD) that has been designed to meet the most critical patient and user needs with:
Elevate your compounding with APEX®.
The process of parenteral nutrition starts with a prescription. B. Braun’s nutrition management software Clinus simplifies and optimizes the prescription of clinical nutrition and offers a closed loop from prescription to administration. The software can be connected to your hospital information system (HIS).
This simplifies the process of parenteral nutrition in a closed loop from prescription to administration, and if connected to a hospital information system, it also includes the documentation to ensure a human error-free transcription of the regimen and eliminate an important risk factor.
Pharmacist scanning barcode for automated tpn compounding
When transcribing the composition of the regimen from the label to the mixture, the error risk is particularly high. APEX® can read and process prescriptions derived from several established prescription software writing PAT-files or QR codes with the regimen on the label and therefore reduce the risk of transcribing errors. The B. Braun software Clinus writes the composition of the regimen as a QR code on the label.
This simplifies the process of parenteral nutrition in a closed loop from prescription to administration, and if connected to a hospital information system, it also includes the documentation to ensure a human error-free transcription of the regimen and eliminate an important risk factor.
Compatibility is a crucial point for patient safety. Parenteral nutrition regimens are complex mixtures, and it is difficult to predict whether the prescribed mixture will be compatible and stable or not. Since the prescriptions are according to the patient’s needs it is the pharmacist’s responsibility to assure that they can be mixed and administered safely. With B. Braun’s compatibility software EasyComp the pharmacist can check compatibility and stability of a regimen before he or she prepares the mixture. If compatibility is not confirmed, EasyComp allows corrective measures to make the mixture compatible. If compatibility is confirmed, provides a stability statement, shelf life, can print labels, worksheets, and prescription sheets if necessary.
26 ports minimize the number of ingredients to be added manually. The transfer set is pre-assembled for easy and fast set-up and to avoid any touch contamination when assembling a set. It is barcoded, color-coded, and numbered to avoid mix-up of solution lines. The set comes with seven flex lines, which allow the dispensing of solution in the macro- or micro-line from the same source container, depending on the volume to be dispensed. For volumes less than 10 ml, it is pumped through the micro line, for volumes larger than 10 ml, it is pumped through the macro line, which is up to six times faster.
APEX® is a compact, state-of-the-art compounder with latest technology for preparation of various solutions. It comes with
Around the APEX® compounder, B. Braun offers a complete package for the process of compounding of parenteral nutrition – from order entry to final documentation. We have software for order entry, provide barcodes for error-free transcription, we offer compatibility software, a comprehensive set of disposables, fast, reliable, and accurate preparation, delivery, and documentation.
The main benefit of an automated compounder is, that it reduces the risk of human error because the transcription of regimens is read out electronically with a barcode scanner directly from the label and it provides a higher accuracy of delivery. Automated compounding is also less labor-intensive allowing for more daily preparations.
If the compounder is connected to a hospital information system, direct electronic filing and documentation are possible.
[1] Miller MR, Robinson KA, Lubomski LH, et al. Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. BMJ Quality & Safety 2007;16:116-126.
[2] Cowley E, Williams R, Cousins D. Mediaction errors in children : a descriptive summary of medication error reports submitted to the United States pharmacopeia. Current Therapeutic Research 2001;62(9) :627-640.
