The establishment and application of the standard operation procedure of total intravenous nutrition medicine

  total parenteral nutrition (TPN) refers to the various nutrients the body needs according to certain After mixing the ratio and concentration, the injection is directly injected into the body by intravenous drip [1]. It includes carbohydrates, fat emulsions, amino acids, vitamins, electrolytes and trace elements. The mixed input of various components is conducive to better utilization and metabolism of the body, and has become one of the comprehensive treatment measures for critically ill patients. Since TPN contains a variety of complex sterile preparations, its sterility, compatibility and stability are of utmost importance. We formulate standard operating procedures for the preparation of total intravenous nutrition drugs to ensure the quality requirements and medication safety of total intravenous nutrition preparations.
  1 General information on
  our hospital is a tertiary level Cancer Hospital, intravenous configuration center has staffing of 53 people, the hospital is responsible for configuring the work of all intravenous drug hospitalized patients, total parenteral nutrition pharmacy which amount to 170 to 220 per day bag.
  2 total parenteral nutrition pharmacy establish standard operating procedure
  2.1 Survey analyzes the problems existing operational processes
  using a self-designed red with staff TPN punch with the implementation of the checklist process with staff and rushed TPN configured awareness survey, Investigation of the status quo found that the original configuration process had the following shortcomings: ① The implementation details of the original operation process were not specific, resulting in deviations in implementation. ②As most of the preparation staff are nursing staff, they do not have comprehensive knowledge of pharmacology. ③The supervision and reminder are not in place.
  2.2 Detailed rules of the standard operating procedure
  for the preparation of total intravenous nutrition drugs 2.2.1 Prepare the preparation personnel with neat clothes and hats before configuration, and wear clean laminar flow suits. Prepare all the items used before configuration to avoid increasing the chance of pollution due to repeated walking.
  2.2.2 Check the mixed materials, including the validity period of the nutrition bag, the tightness of the package, whether there are cracks, whether the performance of the infusion tube clamp and the retention clamp are intact, and the infusion label scan code.
  2.2.3 The 75% alcohol gauze wipes the interior of the horizontal laminar flow table from top to bottom and from the inside to the outside.
  2.2.4 Carefully check the patient’s age, drug name, specification, dosage, medication time, medication frequency, and drug validity period and completeness of the infusion label. And check whether the compatibility of the medicines and the dosage of the medicines are reasonable. After confirming that they are correct, place the medicines in an orderly manner (the medicines are on the top and the solvent is on the bottom) for disinfection.
  2.2.5 Configure according to the order of mixing and mixing ① Add phosphate (Glyphos) and trace elements (such as Andamex, etc.) to the amino acid solution separately and mix thoroughly to avoid excessive local concentration. ②Add electrolytes and insulin to glucose or sugar salt solution separately and mix thoroughly. ③After dissolving the water-soluble vitamins with fat-soluble vitamins, add them to the fat emulsion and mix well. ④Mixed and mixed injection drugs, the infusion label and drugs should be checked before, during and after the operation.
  2.2.6 Check and open the disposable intravenous nutrition bag before filling and close all infusion tube clamps. Paste the infusion label on the upper left corner of the front of the nutrition bag to avoid covering the scale.
  2.2.7 When filling, first fill glucose or sugar salt solution, amino acid solution, press slowly, and mix well. Close the corresponding infusion tube clamp in time to prevent too much air from entering. Check the quality of the liquid in the infusion bag.
  2.2.8 Finally, pour the fat emulsion, press slowly, and mix well. Close the corresponding infusion tube clamp in time to prevent too much air from entering.
  2.2.9 For mixed filling, the infusion label and medicine should be checked before, during and after operation.
  2.2.10 Remove the part of the liquid inlet pipe, drain the air from the bag, then clamp the shut-off clamp, and put a sterile cap on the mouth of the infusion pipe.
  2.2.11 Check the label information of the infusion, check the quality of the finished infusion, and squeeze the three-liter bag to check for liquid leakage.
  2.2.12 Qualified products will be sent out to the deployment room, and unqualified products will be reported for damage and re-allocated.
  2.3 Precautions
  2.3.1 The mixing and deployment should be carried out in a horizontal laminar flow table strictly in accordance with aseptic technique.
  2.3.2 Strictly follow the standard operating procedure of total intravenous nutrition medicine for mixing and deployment, and do not change the order of deployment at will to ensure its stability.
  2.3.3 Phosphorus and calcium preparations cannot be mixed into a unified carrier to avoid the formation of calcium phosphate precipitation.
  2.3.4 Electrolytes should not be directly added to fat emulsion to avoid destroying the molecular structure of fat emulsion.
  2.3.5 Fat emulsion has PH<5 and loses its stability, so glucose cannot be directly mixed with fat emulsion.   2.3.6 After completing a set of mixing operations, immediately clean the countertop and wipe the countertop with 75% alcohol gauze.   2.3.7 To ensure the safety and effectiveness of intravenous hypernutrition, it is not advisable to add other drugs or drugs to TPN.   2.3.8 The finished product should be used immediately after being sent to the ward. If it needs to be stored, it should be placed at 2~8℃, and the storage time should not exceed 16 hours.   3 staff training and the implementation of   the total parenteral nutrition pharmacy establish standard operating procedures, processes record mark of instructional videos, regular loop, and special training to learn. Prepare the standard operation flow chart for the configuration of total intravenous nutrition medicine, and publish it to the department learning group on a regular basis, and conduct operational assessments one by one. Supervise, feedback and track in actual work after training.   4 Experience   Optimization establish total parenteral nutrition pharmacy standard operating procedure is to ensure drug safety and stability improvements targeted, can effectively promote the punch with a punch code enforcement personnel with the operation, every aspect of the operations are under control, the maximum Ensure configuration quality. Therefore, the establishment and implementation of a standard operating procedure for the preparation of total intravenous nutrition drugs is of great significance to improve the quality of total intravenous nutrition drugs in our hospital and to ensure the safety and stability of total intravenous nutrition drugs.