Parenteral nutrition program in a major cancer center

In this article, formulation ordering, manufacturing procedures, and the quality control techniques utilized by the parenteral nutrition program at Memorial Sloan-Kettering Cancer Center are described. The cancer patient's metabolic status frequently changes; therefore, individualized prescriptions are used for all parenteral nutrition solutions. Due to the cancer patient's high risk of infection, related to disease-induced or iatrogenic immunosuppression, strict attention to aseptic procedures is required, including personnel wearing disposable gowns, head and shoe coverings, face masks, and surgical gloves. Specific emphasis has been placed on maximal cost effectiveness in manufacturing protocols. Preparation of solutions is, however, only one component of the role played by the pharmacists on the nutrition team. We describe the clinical responsibilities which are of paramount importance, since medications and other treatment modalities can markedly alter nutritional status and electrolyte balance. Monitoring the medications a patient receives and carefully watching a patient's laboratory results are important functions of the pharmacist. For the cancer patient, particular emphasis must be placed on nutritional and metabolic aberrations caused by antibiotics, corticosteroids, diuretics, antineoplastic agents, and narcotic analgesics. Radiation therapy can result in serious physiologic and nutritional effects. An innovative patient profile for monitoring a cancer patient receiving parenteral nutrition is introduced. The pharmacists are also involved in several teaching programs and a new outpatient program for administration of I.V. antibiotics to selected home total parenteral nutrition patients.