01-12-2018 09:51 PM
Our institution batch compounds starter TPN syringes (trophamine, dextrose, calcium gluconate, and sterile water for injection) for pediatric patients. We consider this to be medium risk compounding and assign a 9 day BUD as they are kept refrigerated. On many occasions, physicians will order additional electrolytes to be added to the starter TPN syringe. There are two different schools of thought in our institution on how to handle these requests. One side feels that it is permissible to take one of the batch compounded syringes, add the additional electrolytes to this syringe, and assign a 24 hour BUD to this altered product. The other side feels it is not permissible to modify a previously batch compounded product and that a completely new patient-specific syringe should be made that includes the additional electrolytes. Both sides are looking to me to provide guidance. I am unable to find anything addressing this practice. Any assistance would be greatly appreciated.
01-18-2018 09:24 AM
Agree with the second one. Once you prepare a syringe or a bag and assign a BUD (e.g., 9 days), that syringe / bag is considered to be a signgle dose vial/container. Once you puncture it, it is only good for 6 hours under the hood.
01-19-2018 12:07 PM
We have been down this road at our institution. We instituted that a starter TPN is to never be altered. What is there is there and the formula is to not be altered. The starter TPN for evenings / nights and before the compounder has been setup. Once the compounder is setup, we can then prepared a small volume bag before we send up the 24 hours bag at 1630