The clinical impact of using commercially available multi-chamber bags compared to bespoke manufactured bags for home parenteral nutrition patients with chronic Intestinal Failure

Abstract

Commercially available multi-chamber bags (MCBs) have been widely used for inpatients. However, in recent years there has been an increase in the use of MCBs for home parenteral nutrition. Various studies have been conducted to compare the safety and cost-effectiveness of MCBs and bespoke manufactured bags, although few studies have evaluated the clinical impact of increased MCB use on patient outcomes. The aim of this study was to compare the rate of home parenteral nutrition HPN-related hospital admissions, ambulatory care visits, telephone consultations and prescription alterations amongst patients prescribed MCBs compared with bespoke manufactured bags. Method This was a retrospective single centre cohort study carried out at a specialist Intestinal Failure (IF) centre. Patients discharged on HPN with chronic IF between 1st August 2019 and 1st August 2022 were included. Patients were prescribed MCB or bespoke PN bags according to the clinical need. Patients discharged on parenteral fluids were excluded. We compared the number of hospital attendances, nutrition support team contacts and prescription changes between the two cohorts over a two-month period post discharge. Data was collected using the hospital electronic medical record and prescribing system. Results A total of 38 patients were discharged on HPN, where 24 patients were on MCBs and 14 patients on bespoke formulations. Incidence rate of first emergency admission within 2 months in MCB group was lower than that in bespoke group (0.17 vs. 0.21; p = 0.64; 95% CI: (-0.30, 0.21)). Mean number of emergency presentations, ambulatory care visits, inpatient admissions and telephone encounters were 0.38 vs. 0.21, 0.38 vs. 0.21, 0.21 vs. 0.29 and 2.25 vs 2.07 in the MCB group and bespoke group respectively. There are 23 prescription alterations within 2 months of discharge, and 10 of them are changes within bespoke group. Conclusion This retrospective single centre cohort study demonstrates that there is no significant difference between the rate of emergency admissions, ambulatory care visits, telephone consultations and prescription alterations between the patients discharged on MCBs and bespoke manufactured PN. Although prescriptions for MCBs have more alterations than bespoke PN, following hospital discharge, this study demonstrates that there is no difference in the clinical impact of the two different parenteral nutrition bags on patient outcomes. References 1. Reber E, Messerli M, Stanga Z, Muhlebach S. Pharmaceutical Aspects of Artificial Nutrition. J Clin Med. 2019 Nov 19;8(11):2017. 2. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN practical guideline: Home enteral nutrition. Clin Nutr. 2022 Feb;41(2):468-488.