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Extending total parenteral nutrition hang time in the neonatal intensive care unit: Is it safe and cost effective?

Content:
Balegar V, Azeem M, Spence K, Badawi N. Extending total parenteral nutrition hang time in the neonatal intensive care unit: Is it safe and cost effective? J Paediatr Child Health. 2013 Jan 2013;49(1):E57-61.

AIM: To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload.
METHODS: A before-after observational study comparing the practice of hanging TPN bags for 48?h (6 February 2009-5 February 2010) versus 24?h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload.
RESULTS: One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442?g (±101) versus 2476?g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97?603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced.
CONCLUSION: Extending TPN hang time from 24 to 48?h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.
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posted on IV team Jan 20, 2013

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