{
  "abstract": "Aim Critically ill neonates and children often require Parenteral Nutrition (PN) due to their inability to tolerate enteral feeding. PN provides essential nutrients but poses challenges when patients also need other intravenous (IV) medications, especially in patients with limited IV access. Incompatibilities between PN and other drugs can necessitate citing new lines, pausing PN (potentially compromising nutritional support and patient recovery) or blocking lines due to precipitation. This audit aimed to determine how often PN must be paused due to incompatibilities, assess the nutritional impact of these pauses, and identify IV drugs prescribed alongside PN.Method Trust Clinical Audit registration was completed. Data were collected once or twice weekly over 12 sessions (September to December 2024) for patients prescribed PN in a specialist paediatric hospital. Data recorded included PN type, IV-line type, concurrent IV drugs, compatibility status according to Trust guidelines, adverse effects and nutritional consequences associated with unplanned pauses to PN regimens.Results Data were recorded for 89 PN episodes in 41 patients aged between 3 days and 19 years, across 8 wards. Some patients were audited multiple times. Bespoke PN was mostly prescribed (57 episodes), followed by Numeta G16%E (17), G13%E (6), G19%E (3), and Kabiven (6). The majority of patients had a single lumen central line (52 episodes).There were 262 instances of IV drugs being prescribed concurrently with PN, involving 48 different drugs (range 1-19 per patient, mean 3, median 2).160 of these instances involved drugs not listed in Trust compatibility guidelines., Only 7 of these drugs (on 23 occasions) were actually co-administered via the same line as PN (esomeprazole, chlorphenamine, milrinone, midazolam, rocuronium, furosemide and magnesium sulphate). No drugs listed as incompatible in Trust guidelines were co-administered via the same line as PN. Further research, however, identified evidence of incompatibility of PN with esomeprazole1 and midazolam2 3 and mixed compatibility/incompatibility data with furosemide2 4 although no problems were observed during co-infusion.No adverse effects were observed. No unplanned PN pauses due to incompatibility causing adverse nutritional consequences were identified in the episodes for which data were collected. Data on requirements for new line placements or delays to starting PN due to IV access or incompatibility was not captured.Conclusions The audit found no evidence of PN administration being significantly disrupted due to incompatibility with concurrent IV drugs. However, a large number of IV drugs were prescribed alongside PN and Trust compatibility guidelines were found not to include some of these commonly used drugs with definitive evidence of incompatibility.There is a need for an expanded compatibility guideline to be developed which will be the focus of future work.References Bouchoud L, Fonzo-Christe C, Klingmüller M et al. Compatibility of intravenous medications with parenteral nutrition: in vitro evaluation. Journal of Parenteral and Enteral Nutrition 2013;37(3):416–424.Trissel LA, Gilbert DL, Martinez JF et al. Compatibility of parenteral nutrient solutions with selected drugs during simulated Y-site administration. American Journal Health-System Pharmacy 1997;54(11):1295–300.Trissel LA, Gilbert DL, Martinez JF et al. Compatibility of medications with 3-in-1 parenteral nutrition admixtures. Journal of Parenteral and Enteral Nutrition 1999;23(2):67–74Staven V, Wang S, Grønlie I et al. Physical stability of an all-in-one parenteral nutrition admixture for preterm infants upon mixing with micronutrients and drugs. European Journal of Hospital Pharmacy 2020;27(1):36–42.",
  "authors": [
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Elaine Spencer-Clegg"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Jaclyn Smith"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Christopher Greaves"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Toni Hill"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Louise Bracken"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Lauren Daniels"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Sally Ogden"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Colin Morgan"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Jane Creegan"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Emma Jones"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Jonathon Davies"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Foundation Trust, UK"
      ],
      "name": "Andrea Gill"
    }
  ],
  "title": "P37 Balancing IV medications and parenteral nutrition administration: a neonatal and paediatric audit",
  "uid": "bd7f9132-192a-5b3b-8059-3d8f31c31674"
}