The Experience of Home Parenteral Therapy: A Thematic Analysis of Patient Interviews.

BACKGROUND: A limited number of studies have explored patients' experience with home parenteral (injectable) therapy (HPT) in the UK. AIM: To explore the immediate-, short-, and long-term experience of patients with self-management of any home parenteral therapy with the intention for developing a guideline for service development in the United Kingdom. METHODS AND DESIGN: An interview-based study of patients receiving HPT. Invitations were posted to all patients on the hospital HPT register. The sessions were conducted by telephone for all consenting patients. The interviews were recorded, transcribed, and analysed thematically. Participants completed the 'Health Education Impact Questionnaire' (heiQ) before and after the education session. RESULTS: Of the 640 patients invited to participate in the study, 45 (7%) patients completed the interviews and the education session. An interview analysis revealed that the patients' experiences of HPT were generally positive, but the levels of training and support received showed wide individual variations. The patients had experienced periods of doubt and uncertainty, where they would have appreciated quick access to professional advice to alleviate their concerns. There was a reliable positive change (10.5-18.4%) from before and after the education sessions in six out of the eight domains on the heiQ questionnaire (health-directed behaviour, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, and emotional distress) and moderate change in two domains (5.3% in positive and negative engagement in life, and 2.6% in health services navigation). CONCLUSION: Self-administered parenteral therapy at home is a valuable option, but training and preparation standards should be optimised across hospitals and the wider NHS.

Formulation, stability, and administration of parenteral nutrition with new lipid emulsions.

Intravenous lipid emulsions (IVLE) are an important source of energy and essential fatty acids and their incorporation into pediatric and adult parenteral nutrition (PN) regimens has revolutionized nutrition therapy. However, their clinical use has not been without risk, and will continue to remain so because of the intravenous route of administration. Pharmaceutical and microbiological concerns are centered around the methods of compounding all-in-one (AIO) admixtures, but these can be largely minimized with today's technologies and advanced understanding of aseptic principles. Modern lipid products, based on olive, coconut, and/or fish oils, have demonstrable formulation and clinical benefits over traditional soybean and safflower IVLE and, when combined in the new multi-chamber bags, can also offer improvements in stability and safety. This review outlines the rationale for different lipid formulations in PN admixtures, reviews the factors influencing stability and efficacy of lipid-based AIO regimens and evaluates some technologies for minimizing peroxidation and maximizing stability of AIO admixtures.

Stability and compatibility of histamine H2-receptor antagonists in parenteral nutrition mixtures.

PURPOSE OF REVIEW: To examine the stability and compatibility of histamine H2-receptor antagonists in parenteral nutrition admixtures in order to provide well tolerated and effective therapy. RECENT FINDINGS: Many stability investigations were carried out before 2005, but no critical appraisal of published data has been undertaken. H2-receptor antagonists are stable in most parenteral nutrition admixtures for 2-48 h, with long-term stability up to 4 weeks claimed for a few combinations. Some earlier data are questionable in the light of more recent analytical technology and pharmaceutical knowledge regarding stability assessment. As stability is dependent upon the source of constituents, we have listed all products tested and their respective manufacturers. A general recommendation is made not to store H2-receptor antagonists in parenteral nutrition for more than 24 h at refrigerated temperature before use. SUMMARY: Administration of H2-receptor antagonists in parenteral nutrition admixtures has several clinical and economical advantages, but, in order for these benefits to be well tolerated and efficacious, the stability and compatibility of the drugs, as well as the parenteral nutrition components after mixing, have to be ascertained. Factors that influence stability are assessed, the need for more controlled study protocols is evaluated and recommendations are made for safe storage and administration.