Global Availability of Parenteral Nutrition: Pre- and post-Covid pandemic survey

Background parenteral nutrition (PN) represents a therapeutic option for patients with type 3 intestinal failure (IF). If used exclusively, PN has to be complete to provide all essential nutrients. The aim was to assess the availability of PN in all parts of the world, to better comprehend the global situation, and to prepare an action plan to increase access to PN. Material and Methods an international survey using an electronic questionnaire (EQ) was conducted in August 2019 and repeated in May 2022. EQ was sent to 52 members or affiliates of the International Clinical Nutrition Section (ICNS) of ASPEN. Questions addressed the availability of PN admixtures and their components, reimbursement, and prescribing, pre- and post-COVID pandemic. All participating countries were categorized by their economic status. Results Thirty-six country representatives responded, answering all questions. PN was available in all countries (100%), but in 4 countries (11.1%) 3-chamber bags were the only option, and in six countries multi-bottle system was still used. Liver-sparing amino acids were available in 18 (50%), kidney-sparing in 8 (22.2%), and electrolyte-free in 11 countries (30.5%). In most countries (n=28, 79.4%), fat-soluble and water-soluble vitamins were available. Trace elements (TE) solutions were unavailable in four (11.1%) countries. PN was reimbursed in most countries (n=33, 91.6%). No significant problems due to the coronavirus pandemic were reported. Conclusions Despite the apparent high availability of PN worldwide, there are some factors, which may substantially impact the quality of PN admixtures. These shortages create an environment of inequality.