History of Parenteral Nutrition
Items: 3 Periods, 10 Events (Including Introduction)
Duration: 50 seconds
Filename: H:\TPN Part I\Source Files\Engage\History of Parenteral Nutrition.intr
Introduction
5 seconds
Event Text
Parenteral Nutrition has been evolving for over four decades. While many strides
have been made in the effort to provide total nutrition intravenously, many
challenges and risks still exist.
Click on each circle below or the forward arrow at the top right of the screen to
read about the events of PN development.
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1600's
1616
5 seconds
Event Text
In 1616, circulation of blood in the human body is discovered.
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Reference:
Dudrick SJ. J Am Coll Nutr 2009;28(3):243-251
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1960's
Early 1960's
5 seconds
Event Text
Prior to the availability of IV diuretics (chlorothiazide) in 1962, the concept of
intravenous nutrition had been abandoned due to the high volumes required for
isotonicity of infused solutions. Prior to chlorothiazide, the existing diuretics were
nephrotoxic at doses required when used for long periods of time.
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Reference:
Dudrick SJ. J Am Coll Nutr 2009;28(3):243-251
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Mid-1960's
5 seconds
Event Text
In the mid-1960's, intravenous nutrition advanced significantly due to extensive
laboratory research on parenteral formulations in Beagle puppies. Through this
work, sole nutritional support for growth, development and metabolic support was
demonstrated.
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Reference:
Dudrick SJ. J Am Coll Nutr 2009;28(3):243-251
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Late-1960's
5 seconds
Event Text
Laboratory studies in Beagle puppies provide the foundation for successful trials in
both adult and pediatric human cases.
• Six adults at The Hospital of the University of Pennsylvania were the first to
receive the basic nutrient solution developed as a modified version of the
puppy formulation - all six were surgical patients discharged in good overall
condition despite originally grave prognoses related to malnutrition.
• One newborn, following an extensive resection of more than 95% of her bowel
due to near-total small bowel atresia , survives for 22 months and achieves
normal activity and development for her age while nourished via parenteral
nutrition. Although she eventually died, the experience scientists and clinicians
gained during her management is still unparalleled.
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Reference:
Dudrick SJ. J Am Coll Nutr 2009;28(3):243-251
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1990's to Present
1994
5 seconds
Event Text
FDA Safety Alert of April 1994
Two patients die after receiving peripheral total nutrition admixture (TNA).
Autopsies revealed amorphous deposits of calcium-phosphate in the pulmonary
vasculature.
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Reference:
Food and Drug Administration.Safety Alert: Hazards of precipitation associated with parenteral
nutrition. Am J Hosp Pharm 1994;51:1427-1428
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1995
5 seconds
Event Text
American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) establishes the
National Advisory Group (NAG) on Standards and Practice Guidelines for Parenteral
Nutrition. The NAG was formed to identify problem areas in parenteral nutrition
(PN) therapy specifically related to pharmacy practice after multiple deaths and
injuries were reported.
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Reference:
National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition. JPEN J
Parenter Enteral Nutr 1998;22:49-66
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1997
5 seconds
Event Text
In January 1997, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
Board of Directors approves "Safe Practices for Parenteral and Nutrition
Formulations" to become the standard of practice for the provision of parenteral
nutrition in ALL health care settings. The guidelines provide information on 1)
labeling, 2) standard nutrient ranges, 3) extemporaneous compounding and 4)
stability & compatability of PN formulations.
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Reference:
National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition. JPEN J
Parenter Enteral Nutr 1998;22:49-66
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2004
5 seconds
Event Text
The 1997 publication focused on problem areas in PN therapy specifically related to
pharmacy practice. In 2004, a revised "Safe Practices for Parenteral Nutrition" was
published by A.S.P.E.N. to encompass the interdisciplinary nature of PN and
expanded to include the following topics:
1. Ordering of Parenteral Nutrition
2. Additional information on nutrient ranges to provide dosage recommendations
beyond normal requirements
3. Additional information on filtration and administration of PN
"Safe Practices for Parenteral Nutrition" can be reviewed by clicking on the
"Attachments" tab at the top right of the screen.
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Reference:
Task Force for the Revision of Safe Practices for Parenteral Nutrition. JPEN J Parenter Enteral Nutr
2004;28:S29-S70
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2011
5 seconds
Event Text
A total of 19 patients from six hospitals were adversely affected after receiving PN
contaminated with Serratia marcescens bacteria. Nine of the 19 affected patients
had died, as of April 7, 2011, although the CDC had not confirmed that the deaths
were a direct cause of the contaminated PN.
The ISMP Medication Safety Alert "TPN-Related Deaths Call for FDA Guidance and
Pharmacy Board Oversight of USP Chapter <797>" can be reviewed by clicking on
the "Attachments" tab at the top right of the screen.
Reference:
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Accessed http://www.ismp.org/Newsletters/acutecare/articles/20110407.asp on July 8, 2011
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