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PTH-207 Audit on appropriateness of trace element testing in patients on parenteral nutrition
  1. N Vithanage1,
  2. S Hoey2,
  3. S Sital3,
  4. H Callaby3,
  5. R Prior4,
  6. P Dubois2,
  7. RP Vincent1
  1. 1Clinical Biochemistry
  2. 2Gastroenterology
  3. 3Pharmacy
  4. 4Nutrition and Dietetics, King’s College Hospital NHS Foundation Trust, London, UK

Abstract

Introduction Patients with intestinal failure/those not able to meet nutritional requirements via oral/enteral routes are on long term PN and prone to trace elements (TE) deficiencies. TE are added to the PN, based on recommended daily allowances but requires monitoring to optimise supplementations and we aimed to assess the clinical validity and appropriateness of TE testing in adult patients on PN.

Method The retrospective audit reviewed all patients started on PN between March and July 2014. The audit standards were NICE nutrition guidelines on laboratory monitoring. It recommends TE testing at baseline and every 2–4 weeks. Acute phase responses can alter TE concentrations in the blood thus, confusing the interpretation of results. Therefore, it should always accompanied by CRP). Patients requiring PN >2 weeks were included but those in critical care wards were excluded. Information was obtained from our PN database, pharmacy records and electronic patient records. The data was analysed for the% of appropriate requests,% in which phlebotomy was done and% availability of results.

Results In total 21 patients (27%) received PN >2 weeks. None of the patients had a baseline test. TE and CRP were ordered only in four patients (19%). Total number of requests for these patients was nine but phlebotomy was done only on three occasions (33%). All samples received by the lab were processed (100%).

Conclusion Adherence to the NICE guidelines was very poor. The phlebotomy failure was multifactorial and is under review. A routine baseline TE test adds very little to clinical management as it is difficult to foresee which patients require PN >2 weeks. Furthermore, from our previous experience TE should only be tested when CRP is <20 mg/L which will exclude almost all critically ill/immediate post-op patients.

Disclosure of interest None Declared.

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