Page 50 - Avoid Food and Drug Interactions

Learning Assessment Answers:
1. Answer = A; Rationale: Based on ASPEN Guidelines for the Selection and Care of Central Venous
Access Devices for Adult Home Parenteral Nutrition Administration and ASPEN Consensus
Recommendations: When in Parenteral Nutrition appropriate, the selection of a CVAD should include the
smallest device to meet the needs of the patient, along with as few lumens as possible.
2. Answer = A; Rationale: Based on newer research from Doig et al, Harvey et al, and Heidegger et al, when
PN use was compared to EN use or standard care, there was no statistically significant difference in
infectious complications or mortality.
3. Answer = B; Rationale: While the ASPEN/SCCM guidelines suggest withholding soybean oil ILE’s or
limiting the dose of soybean oil ILE’s for the first 7-10 days of critical illness, conflicting evidence has
shown that there is not difference in infectious outcomes when early ILE use was compared to delayed
ILE use (Gerlach AT. Surg Infect. 2011;12(1):43-47.). Based on data demonstrating improved outcomes
with the use of early PN (Doig G. JAMA.2013;309(20):2130-2138.) and supplemental PN (Heidegger CP.
Lancet.2013;381:385-393), withholding lipids may increase the risk of muscle loss, nosocomial infections
and worsen the risk of malnutrition.
4. Answer = C; Rationale: Alternative ILE’s contain less essential fatty acids depending on their lipid
breakdown. Use of soybean oil ILE’s are often limited to a dose of <1 g fat/kg/day. It is possible that
patients will receive inadequate essential fatty acids if receiving an olive oil-soybean oil ILE or a 4-oil ILE.
The dose to prevent EFAD will vary depending on the alternative ILE used, but generally should be at
least 1g fat/kg/day.

References
1. Kovacevich DS, Corrigan M, Ross VM, McKeever L, Hall AM, Braunscweig C. American Society for
Parenteral and Enteral Nutrition Guidelines for the selection and care of central venous access devices
for adult home parenteral nutrition administration. J Parenter Enteral Nutr. 2019:43(1):15-31.
2. Worthington P, Balint J, Bechtold M, Bingham A, Chan L-N, Durfee S, Jevenn AK, Malone A,
Mascarenhas M,Robinson DT, Holcombe B. When is parenteral nutrition appropriate? J Parenter Enteral
Nutr. 2017;41:324-377)
3. Gerlach AT, Thomas S, Murphy CV, et al. Does delaying early intravenous fat emulsion during parenteral
nutrition reduce infections during critical illness? Surg Infect. 2011;12(1):43-47.
4. Edmunds CE, Brody RA, Parrott JS, Stankorb SM, Heyland DK. The effects of different IV fat emulsions
on clinical outcomes in critically ill patients. Crit Care Med 2014; 42:1168–117.
5. Grau-Carmona T, Bonet-Saris A, Garcia-de-Lorenzo A, Sanchez-Alvarez C, Rodriguez-Pozo A, Acosta-
Escribano J, Minambres E, Herrero-Meseguer JI, Mesejo A. Influence of n-3 polyunsaturated fatty acid
enriched lipid emulsions on nosocomial Infections and clinical outcomes in critically ill patients: ICU lipids
study. Crit Care Med 2015;43:31-39.
6. Mundi MS, McMahon MT, Carnell JJ, Hurt RT. Long-term use of mixed oil lipid emulsions in adult home
parenteral nutrition patients: a case series. Nutr Clin Pract. 2018;33(6):851-857.
7. Klek S, Szczepanek K, Scislo L, Walewska E, Pietka M, Pisarka M, Pedziwiatr M. Intravenous lipid
emulsions and liver function in adult chronic intestinal failure patients: results from a randomized clinical
trial. Nutrition. 2018;55-56:45-50.
8. Honeywell S, Zelig R, Radler DR. Impact of intravenous lipid emulsions containing fish Oil
on clinical outcomes in critically ill surgical patients: a literature review. Nutr Clin Pract. 2019;34(1):112-
122.
9. Abbasoglu O, Hardy G, Manzanares W, Pontes-Arruda A. Fish oil-containing lipid emulsions in adult
parenteral nutrition: a review of the evidence. J Parenter Enteral Nutr. 2019;43(4):458-470.

50