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Respiratory Distress and Sudden Death Associated with Receipt of a Peripheral Parenteral Nutrition Admixture

Published online by Cambridge University Press:  02 January 2015

David K. Shay ,
Lynda M. Farm  and
William R. Jarvis
David K. Shay*
Affiliation:
The Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Lynda M. Farm
Affiliation:
The Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
William R. Jarvis
Affiliation:
The Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-69, Atlanta, GA 30333
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Abstract

Objective:

To detect respiratory adverse reac¬tions potentially related to receipt of peripheral parenteral nutrition (PPN) in hospitalized patients and to determine risk factors for their occurrence.

Design:

Retrospective cohort study.

Setting:

Federal tertiary-care hospital.

Patients:

Medical and pharmacy records of all patients who received PPN from October 1992 to February 1994 were abstracted for demographics, diagnoses, medications received, indications for and formulation of PPN, and severity of illness as measured by Acute Physiology and Chronic Health Evaluation II scores.

Results:

A case-patient was defined as any patient who, while receiving PPN, had unexplained chest pain, dyspnea, cardiopulmonary arrest, or new interstitial infiltrates on chest radiograph. Patients who received PPN in which FreAmine was the amino acid source were more likely than those who received PPN made with Travasol to meet the case definition (5/11 vs 0/39; relative risk, >18; 95% confidence interval, 3.3->136; P<.001).

Conclusions:

A change in the amino acid source of a PPN admixture was associated with respiratory adverse events that ranged from interstitial infiltrates to sudden death. These events apparently resulted from the infusion of a calcium phosphate precipitate in an opaque admixture. Each new PPN admixture should be tested for stability before clinical use and infused into patients through an appropriate filter.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 12 , December 1997 , pp. 814 - 817
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Pomerance, HH, Ruder, RE. Crystal formation: a new complication of total parenteral nutrition. Pediatrics 1973;52:864–866.CrossRefGoogle ScholarPubMed
2. Knight, PJ, Buchanan, S, Clatworthy, HW. Calcium and phosphate requirements of preterm infants who require prolonged hyperalimentation. JAMA 1980;243: 1244–1246.CrossRefGoogle ScholarPubMed
3. Robinson, IA, Wright, BT Central venous catheter occlusion caused by body-heat-mediated calcium phosphate precipitation. Am J Hosp Pharm 1982;39:120–121.Google ScholarPubMed
4. Breaux, CW Jr, Duke, D, Georgeson, KE, Mestre, JR. Calcium phosphate crystal occlusion of central venous catheters used for total parenteral nutrition in infants and children: prevention and treatment. J Pediatr Surg 1987;22:829–832.CrossRefGoogle ScholarPubMed
5. Stennett, DJ, Gevwick, WH, Egging, PK, et al. Precipitate analysis from an indwelling total parenteral nutrition catheter. JPEN 1988;12:88–92.CrossRefGoogle ScholarPubMed
6. Knowles, JR, Cusson, G, Smith, M, Sitrin, MD. Pulmonary deposition of calcium phosphate crystals as a complication of home total parenteral nutrition. JPEN 1989;13:209–213.CrossRefGoogle ScholarPubMed
7. Food and Drug Administration. Safety Alert: hazards of precipitation associated with parenteral nutrition. Am J Hosp Pharm 1994:51:1427–1428.Google Scholar
8. Eggert, LD, Rusho, WJ, MacKay, MW, et al. Calcium and phosphate compatibility in parenteral nutrition solutions for neonates. Am J Hosp Pharm 1982;39:49–53.Google ScholarPubMed
9. Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Cñt Care Med 1985;13:818–828.CrossRefGoogle ScholarPubMed
10. Rothman, KJ, Boice, JD Jr. Epidemiologic Analysis With a Programmable Calculator, 2nd ed. Chesnut Hill, MA: Epidemiology Resources Ine; 1982.Google Scholar
11. Hill, SE, Heldman, LS, Goo, EDH, Whippo, PE, Perkinson, JC. Fatal microvascular pulmonary emboli from precipitation of a total nutrient admixture solution. JPEN 1996;20:81–87.CrossRefGoogle ScholarPubMed
12. National Coordinating Committee on Large Volume Parenterals. Recommendations to pharmacists for solving problems with large-volume parenterals. Am J Hosp Pharm 1980;37:663–667.Google Scholar
13. Dickerson, RN, Brown, RO, White, KM. Parenteral nutrition solutions. In: Rombeau, XL, Caldwell, MD, eds. Clinical Nutrition, Volume 2: Parenteral Nutrition. 2nd ed. Philadelphia, PA: WB Saunders; 1993:322,Google Scholar
14. Driscoli, DF, Bacon, M, Provost, PS, Bistrian, BR. Automated compounders for parenteral nutrition admixtures JPEN 1994;18:385–386. Letter,CrossRefGoogle Scholar
15. Mirtalio, JM. The complexity of mixing calcium and phosphate Am J Hosp Pharm 1994;51:1536–1537. Editorial.Google Scholar