Risks

There are 3 stages of the parenteral nutrition (PN) administration process considered to be particularly prone to errors which can result in unintentional rapid infusion and subsequent patient harm.

Delivery device set up

Confusion between the rates of the two components of the PN could lead to the delivery devices being set up to administer the lipid component at the rate intended for the aqueous component and vice versa.

User error in setting the appropriate delivery rate may lead to over or under infusion.

Calculation of delivery rate

A calculation error at the point of setting up or making any necessary changes may lead to infusion rate errors.

Attaching to the patient

Not removing the old bag before hanging the new bag can result in confusion over which giving set is to be placed in the delivery device.

Unintentionally attaching the PN bag administration set to the cannula before placing it in the delivery device could result in the PN running in free flow.

The use and number of octopus extensions can increase the potential for error.

Mitigation

Consideration should be given to the following to help mitigate the risk of error

Product choice

Review the products used within the organisation and consider if an all-in-one PN product is suitable for patients.

Administration principles

Ensure that local policies and procedures are in place, where appropriate, to support the safe use of PN.

Standards related to appropriate infusion devices, administration sets, administration labelling and checking requirements, rate change checks may all support safe use of PN.

Competency training

Ensure local training and competency requirements meet standards outlined in any neonatal and paediatric PN policy.

Safety software

Prudent use of electronic safety functions, such as infusion rate limits in infusion software may limit harm.

Infusion equipment

Ensure the organisation’s infusion devices for PN administration are fit for purpose.

Consider using different administration pumps and sets to aid differentiation between PN components.

Labelling of administration sets may aid differentiation between PN components.

Monitoring

Consideration should be given to the expected monitoring frequency, including nursing administration checks such as volume infused in last hour, to ensure that any errors in infusion rate are picked up in a timely fashion.

Acknowledgements

We are grateful for the input from NHS colleagues working in paediatrics and the Neonatal and Paediatric Pharmacists Group (NPPG).