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Trissel'sTM Ca/P Check

Preface

For pharmacists, nurses, dietitians, and physicians working with parenteral nutrition, making decisions regarding the compatibility of calcium and phosphate in these complex multi-component admixtures is an essential function. Because of the occurrence of adverse clinical consequences of unrecognized calcium phosphate precipitation in parenteral nutrition, including deaths, this has been and remains a substantial patient safety concern.

The interaction of calcium and phosphate in parenteral nutrition admixtures is the most frequently studied single parenteral drug compatibility issue reported in the published literature. There are numerous published formal research studies as well as observational reports. And yet accessing that information by practitioners working in clinical settings has been problematic.

The published articles have been in disparate sources and have appeared over two decades. Other informational resources to aid these practitioners in the decision-making process are relatively scant. Consequently, many practitioners have not had the resources immediately at hand so they may base calcium and phosphate compatibility decisions on the research information that is available. But that has now changed.

Trissel’s ™ Calcium and Phosphate Compatibility in Parenteral Nutrition brings together in one source the available published research information on calcium and phosphate compatibility to aid pharmacists, nurses, and dietitians in their compatibility decision-making process. Included in this work are calcium and phosphate compatibility test results on representative parenteral nutrition admixtures prepared from a variety of varying component products. The information is available in a convenient pocketsize book that can be kept immediately at hand in a lab coat pocket or other convenient location and also in an electronic database.

 

Display of the Information

Most practitioners have found that graphic displays of the compatibility results are the easiest to use in a rapid manner in the clinical environment. Because of this, all of the research result information in Trissel’s ™ Calcium and Phosphate Compatibility in Parenteral Nutrition has been prepared in standardized graphs.

The most familiar format from the published literature, plotting the concentration of phosphates (in mmol/L) on the X-axis and calcium (in mEq/L) on the Y-axis, has been utilized throughout. The published ‘compatibility curves,’ or boundaries between compatible and incompatible concentrations have been adapted from the original research but presented in this standardized format. Compatibility information that was presented in tabular form or used alternative graphic presentation has also been adapted to this standardized graphic presentation.

The published research results for each parenteral nutrition formula are presented separately. For each admixture that has been reported, the test parenteral nutrition formula, study goals, study methods, and the literature reference are presented on one page. The facing page presents the published compatibility results in standardized graphic form.

The compatibility information is grouped alphabetically by amino acids source product and arranged within the group from lowest to highest amino acids concentration. Formulas with the same amino acids concentrations are arranged from lowest to highest dextrose concentration. The admixture formulas represent the final concentrations of the components in the finished admixtures.

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