Survey on medication administration to patients receiving parenteral nutrition

Background : Multiple medications are often administered simultaneously during parenteral nutrition, typically using a three-way stopcock. Therefore, care must be taken regarding infection control during catheter handling and changes in drug compositions within the catheter. Consequently, flushing is performed before and after drug administration via the side port to flush the inside of the three-way stopcock and the catheter lumen. However, detailed management methods for flushing procedures are not specified in guidelines, and it is presumed that many facilities leave this to individual discretion. Objective : A questionnaire survey was conducted on the actual practice of administering parenteral nutrition. This research was performed with the aim of contributing to the appropriate use of drugs and infection control in the future and also assisting in the formulation of guidelines. Methods : A request for survey cooperation was sent to hospitals belonging to the Osaka Prefecture and Nara Prefecture Societies of Hospital Pharmacists. A questionnaire survey was conducted using Google Forms from September 2024 to January 2025, targeting 75 hospitals that responded positively to participate. Approval was obtained from the Ethics Committee of the Faculty of Pharmacy, Osaka Otani University (BE-0096-24). Results : Responses were obtained from 63 facilities (84%). The sterile preparation of Total Parenteral Nutrition (TPN) solutions was performed in 41 facilities (65%), with pharmacists being involved in infection prevention and control and pharmaceutical management. However, this was only the case for Peripheral Parenteral Nutrition (PPN) solutions in 9 facilities (14%). Furthermore, as many as 20% of facilities administered lipid emulsions at inappropriate infusion rates. The present results also revealed the lack of standardization regarding the volume or method of administration for the flush before and after drug administration. Discussion: Many facilities perform the aseptic preparation of TPN solutions; however, pharmacists are not involved in the aseptic preparation of PPN solutions. Furthermore, there are currently no established guidelines for medication management involving devices such as three-way stopcocks, and pharmacists are unable to intervene. Further pharmacist involvement is necessary to ensure the appropriate administration of parenteral nutrition solutions.