Although from a paediatric view point but our network has been using standard PN solutions for quite some time now and it’s seems to be the growing trend throughout major paediatric tertiary hospitals throughout the country.
It was a little strange at the beginning for me when I started this role as I always learnt that “from scratch” bags are usually the best for paediatric patients and hard to have a “one size fits all” solution.
However, with careful calculations and ensuring PN is prescribed by specialised teams – standard solutions have worked well. We have recently reviewed our current standards and we have managed to keep the options to a small number (excluding the neonatal group for their PN solutions have been standardised on a state level some time ago – this was an impressive project!).
We are guided by Baxter manufacturing whenever we manipulate standard bags in our sterile suite and a renewed shelf life or expiry of a manipulated solution is allocated by Baxter according to their in house studies. Usually our additions involve adding trace elements and multivitamins and some extra electrolytes. Fat emulsions are given separately.
Deletion of any electrolyte component will obviously require a bag to be made up from scratch.
It does save on labour costs for us and free up pharmacists from being in the hood most of their day. Our pharmacy trading hours and dynamics and technology in the sterile suites differ quite a bit to standards abroad, hence why PN premixes have been a life saver for resource challenged settings.
Hope this helps you see things from a different angle.