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Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?

Kiran Kumar Balegar V1, Mohammad Irfan Azeem, Kaye Spence

  • 1Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney University, Sydney, New South Wales, Australia. kiranbal@rediffmail.com

Journal of Paediatrics and Child Health
|January 17, 2013
PubMed

Insights

Extending total parenteral nutrition (TPN) bag hang time to 48 hours did not increase central line-associated blood stream infection (CLABSI) rates. This practice also reduced TPN costs and nursing workload, offering significant benefits.

Area of Science:

  • Neonatal intensive care
  • Infectious disease control
  • Healthcare economics

Background:

  • Central line-associated blood stream infections (CLABSI) are a significant concern in neonatal intensive care units.
  • Total parenteral nutrition (TPN) is a critical intervention for neonates, but its administration involves risks and resource utilization.
  • Current practices often limit TPN hang time, potentially increasing costs and nursing workload.

Purpose of the Study:

  • To evaluate the impact of extending TPN fluid hang time from 24 to 48 hours on CLABSI rates.
  • To assess the effect of prolonged TPN hang time on TPN-related expenses.
  • To determine the influence of extended TPN hang time on nursing workload in a neonatal intensive care setting.

Main Methods:

  • A before-and-after observational study was conducted in a tertiary neonatal intensive care unit.
  • The study compared outcomes between a 24-hour TPN hang time period and a subsequent 48-hour TPN hang time period.
  • Key outcome measures included CLABSI incidence, TPN-related costs, and nursing workload assessments.

Main Results:

  • No significant increase in CLABSI rates was observed when TPN hang time was extended to 48 hours (0.4 vs. 0.8 per 1000 line days).
  • Annual cost savings of AUD 97,603.00 were achieved by implementing 48-hour TPN hang times.
  • A majority of nurses reported decreased workload (68.3%) and reduced time spent changing TPN bags (80.5%) with the extended hang time.

Conclusions:

  • Extending TPN hang time to 48 hours is safe regarding CLABSI rates in the neonatal intensive care unit.
  • Prolonging TPN hang time significantly reduces healthcare costs and perceived nursing workload.
  • Further randomized controlled trials are recommended to confirm these findings and guide clinical practice.
Abstract

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