Total Parenteral Nutrition - UMMC

Total Parenteral NutritionS. Krishnan 1 , H. Dhillon 11Pharmacy Unit, University Malaya Medical CenterIntroductionParenteral nutrition refers to the intravenous administration of nutrients to a patientwhen oral or enteral feeding is either inadequate or impossible. Given the risks ofvarious metabolic and mechanical complications, parenteral feeding should only beprescribed when absolutely necessary (Ong et al. 2000).Oral or enteral feeding should be restored as soon as possible to prevent mucosalatrophy of the digestive tract.TPN request• When there is a need for TPN, the physician should contact the TPNpharmacist• An evaluation of the appropriate regimen for the patient will be made by theTPN pharmacist in collaboration with the physician• The TPN Order Form (BK-MIS-416-E01) must be filled and sent to in-patientpharmacy before 11.30 am.• Any requests received after 11.30 am will only be processed the followingworking day• All TPN bags are prepared in the Sterile Complex under stringent asepticcondition and dispatched to the wards by 6 pm• The physician will need to sign the printed prescription and send it back topharmacy the next working day

• If TPN is discontinued for the patient, the ward must inform the TPNpharmacist immediately.• Any unused TPN bags in the ward must be returned to Pharmacy assoon as possible with a memo.Kabiven ®• Kabiven is a ready to use TPN solution reserved for emergency usewhen individualized compounded TPN service is unavailable• All requests for Kabiven must be written on the official UMMCprescription and sent to in-patient pharmacy during working hours• Only one bag is allowed per patient per day. If there is a need for morethan one bag, the doctor should contact the TPN pharmacist• The contents Kabiven in the three separate chambers have to be mixedthoroughly before use• Once mixed, Kabiven is stable for up to 6 days at 2-8 o C• Once removed from the refrigerator, it should be infused within 24hours• Premixed Kabiven bags can be stored at room temperature (