Practical considerations regarding the use of total nutrient admixtures

Area of Science:

• Clinical Nutrition
• Pharmaceutical Science

Background:

• Total Nutrient Admixtures (TNAs), also known as three-in-one admixtures, combine lipid emulsions, dextrose, and amino acids for parenteral nutrition.
• FDA approval of lipid emulsions for TNA use occurred in 1983, facilitating integrated nutritional support.
• The review addresses biological concerns, storage, administration, and benefits of TNAs.

Purpose of the Study:

• To review the biological concerns, proper storage and administration guidelines, and advantages of utilizing TNAs for nutritional support.
• To highlight factors affecting TNA stability, including pH, mixing order, and temperature.
• To discuss practical considerations for TNA administration, such as container safety and pump compatibility.

Main Methods:

• Literature review of existing studies and guidelines on Total Nutrient Admixtures.
• Analysis of factors influencing TNA stability and microbial growth potential.
• Evaluation of practical aspects of TNA administration, including container materials and infusion pump compatibility.

Main Results:

• TNA stability is influenced by pH, order of mixing, and temperature, with conflicting data on microbial growth potential.
• TNA infusate delivery should not exceed 24 hours at room temperature.
• Plastic containers free of diethylhexyl phthalate (up to 3 L) are suitable for TNA administration.

Conclusions:

• TNAs offer practical, nutritional, and potential economic benefits for nutritional support.
• Further research is required to fully understand microbial growth potential, electrolyte and drug compatibilities, and long-term stability of TNAs.
• Careful evaluation of infusion systems and adherence to administration guidelines are essential for safe TNA use.