Since the start of their supply disruption in June 2019, Calea has regularly relied on substituting bespoke compound/prescription parenteral nutrition (PN) bags with ‘off the shelf’ Multi-Chamber Bags (MCBs). MCBs use standard formulations which are kept in separate compartments (usually two or three) which prolongs their shelf life. The plastic seals between the compartments are broken (usually by rolling the bag) in order to mix them just before use.
The main advantages of MCBs are that they are easier to produce and store. They may not require refrigeration and have a far longer shelf life than prescription PN bags. This has proved helpful when patients have to be away from their homes or wish to go on holiday. However, in many cases only short-term use of up to two weeks on MCBs is recommended.
Long-term use of MCBs can have significant consequences on a patient’s health if the patient’s substitute MCBs cannot be matched closely with their previous prescription PN bags. The greater the difference between the prescription PN bags and the MCBs, the greater the potential level of harm caused to a patient.
Standard MCBs contain set quantities of nutrients and electrolytes that cannot be altered in the patient’s home and clearly are not suitable for many patients that require specific nutrient compositions or fluid volumes. Very often, these bags do not contain vitamins and trace elements which have to be added separately or infused alongside.