Your Nutrition Partner to improve Life

Transcription

Clinical Nutrition
Clinical Nutrition
Clinical Nutrition at B. Braun
Clinical Nutrition Therapy is an essential component of comprehensive health care. Individuals with a variety of conditions and
illnesses can improve their health and quality of life by receiving
Clinical Nutrition Therapy. Nutritional support can be provided
either orally (oral nutritional supplements) or through a feeding
tube (Enteral Nutrition) or, when the digestive tract cannot be
used, through an intravenous tube (catheter) that is inserted
directly into the veins (Parenteral Nutrition). The amount, type,
and route of nutrition are tailored specifically to each patient.
Enteral Nutrition support is the provision of nutrients via the
gastrointestinal tract by oral intake or through enteral feeding
tubes. Enteral Nutrition is considered to be the more physiological
form of Clinical Nutrition, as it allows a better utilization of
nutrients and promotes gut function.
The determination of the nutritional status should be part
of each physical examination to identify patients at risk and
to define if an individual nutrition therapy is needed. The
NuTRIscreen-App (please see below) includes different screening
tools, such as "NRS-2002" (Nutrition Risk Score), the "MUST"
(Malnutrition Universal Screening Tool) and the "SGA" (Subjective Global Assessment) to assist health care professionals with
this task. The NuTRIscreen-App is available at the App Store.
Before starting nutritional support, the integrity and function
of the gastrointestinal tract must be assessed to determine
if nutrients should be administered enterally, parenterally or
through a combination of both.
We at B. Braun propose a comprehensive Clinical Nutrition (CN)
approach offering products for both Parenteral and Enteral Nutrition alike. A combined nutritional support allows the fundamental
needs of each patient to be met more directly and can positively
influence clinical outcome.
As your “Nutrition Partner” we allow health care professionals
to choose from a wide product range, with the aim of providing
the patient with required nutrients in any physiological condition. B. Braun offers different services applying to many stages
of the patient pathway, aiming at a patient-centered approach
to ensure the continuity of care.
To keep abreast with additional offerings in Clinical Nutrition,
we recommend a visit to our website: www.nutrition-partner.com.
Nutritional Support / Clinical Nutrition
Enteral Nutrition




2
Functional
gastrointestinal tract
Good tolerance to
Enteral Nutrition



Sufficient enteral
nutrient absorption
Sip feeding /
Oral Nutritional
Supplements (ONS)
Enteral + Parenteral Nutrition

Tube
feeding

Functional
Moderate tolerance to
Enteral Nutrition
Parenteral Nutrition


Non-functional
Poor tolerance to
Enteral Nutrition
Insufficient enteral
nutrient absorption
Tube feeding &
Supplemental

Total
The NuTRIscreen-App:
3
Clinical Nutrition
The B. Braun Clinical Nutrition Service Concept
Discover our portfolio of services
In dialogue with the people who use the company’s products,
B. Braun is continually gaining new knowledge and incorporating
these insights not only into product developments but also into
enhanced support services.
With this approach, we aim to offer value-added services that
optimize working procedures and provide innovative solutions for
all of the many parties accompanying the patient on his pathway
from home to hospital and back again.
In this way, we are able to provide a highly responsive service
platform for a sustainable partnership. It’s a key element of our
company’s values and an essential component of our guiding
principle “Sharing Expertise”.
Clinical Nutrition and the Inpatient Pathway
Nutritional therapy is an important and recognized building block
in the optimal and customized care of your patient.
Patient-customized nutrition compliments any therapy and supports
treatment success. B. Braun is at your side with high quality products and services when it comes to implementing clinical nutrition.
Our support ranges from the screening of patients to the practice of
therapy to the management of any potential complications. A final
crucial step is made when the patient is discharged.
Clinical Nutrition and the Outpatient Pathway
Home Enteral and Parenteral Nutrition has become a life-saving
mainstay of therapy for patients with short bowel syndrome and
for those with severe dysmotility disorders and surgically untreatable intestinal obstruction. However, it is still an unfamiliar mode
of treatment in many health-care settings and even large institutions may struggle with its application and ongoing management.
B. Braun supports patients during their journey from the hospital to
home as well as the interdisciplinary treatment team that accompanies them. The quality of life of the patient, the success of the course
of therapy and trouble-free home care are at the center of what we
do. You can benefit from our decades of experience, and from the
scientifically proven high quality care we offer to ensure the safety
of your patients.
Screening /
Assessment
Admission
Documentation
4
Procurement
of all needed
products
Development
of nutrition
care plan
Evaluation of
home care
setting
Inpatient
Pathway
Monitoring
Discharge Planning
Implementation
of nutrition
care plan
Training of
caregiver
Outpatient
Pathway
Documentation /
Feedback
Reassessment
Monitoring
Offering a complete portfolio of qualified services
5
Binding forward-looking technology …
… with highest treatment quality
Automatic
consideration of
nutrition data
1. Blood sampling
and analysis
Successful therapy requires adequate Clinical Nutrition –
which is why we consider Parenteral and Enteral Nutrition
as an integral part of modern fluid management systems.
2. Input of glucose
value into SpaceControl
Automatic
insulin
application
Automatic calculation of
appropriate insulin rate
and next sampling time
3. Confirmation of
suggested insulin rate
Clinical Nutrition
Modern nutrition therapy involves premixed “convenience”
solutions or nutrition solutions specially made for the patient.
B. Braun standardized nutrition solutions are suitable for most
enteral and parenteral feeding of patients. This approach offers
significant benefits as it prevents errors in administering the
right therapy during the routine of daily clinical practice.
Standardization also reduces nurse’s workloads and the total
cost of preparation.
Enteral Nutrition
B. Braun offers standard and special diets for Enteral Nutrition in
glass bottles and bags. For the delivery of Enteral Nutrition solutions, we also offer resealable nutrition bags which have a fixed,
attached tube for the Infusomat® Space.
Get in touch with the future
B. Braun Space GlucoseControl realizes safe and reliable glucose
levels in critically ill patients with a significantly reduced risk of
hyper- and hypoglycemia.
Infusomat® Space – also ideal for Clinical Nutrition
With this system, beds equipped with the Space system do not
need additional nutrition pumps. Not only does this save staff
time, because additional user trainings are no more required,
it also cuts the cost of maintenance and service.
B. Braun Space GlucoseControl:
Glucose (mmol/l)
20
Conventional Glucose Control
n
B. Braun Space
GlucoseControl
Your benefits:
n
n
n
Protect your budgets by using Infusomat® Space
also for Enteral Nutrition
Prevent mix-up of enteral lines and IV access ports
Reduce nurse’s workloads and the total cost of
preparation with ready-to-use 2- or 3-chamber bags
n
End messy dripping of sticky fluids with PrimeStop
n
No additional training required
Enteral Nutrition
With its intelligent dosage algorithm, the B. Braun Space
GlucoseControl integrates Enteral and Parenteral Nutrition and
exactly determines insulin rate and next sampling time – helping
you to easily control complex work processes for a safer future
with minimized episodes of potentially dangerous hyperglycemia
and hypoglycemia.
15
n
Automatic Integration of Nutrition
n
More safety in daily clinical workflow
n
The solution to achieve safe and reproducible
blood glucose control
Optimized workflow and simplified treatment decision
for more safety in daily use
10
Insulin Pump
5
Space Control
User Interface
Time (hours)
Strict Glucose Control within a range of 4.4–6.1 mmol/l (80–110 mg/dl)
6
7
The NuTRIflex® system for your convenience
Mix – add – mix – infuse
Convenience with Safety
The NuTRIflex® System is the “ready-to-infuse” multi chamber
bag system for Parenteral Nutrition.
The NuTRIflex® System consists of 2- and 3-chamber bags for
peripheral and central venous application, including volume
restricted and electrolyte-free versions.
2-chamber bags
The 2-chamber bags provide different formulations with amino
acids, carbohydrates and electrolytes. According to individual
patient requirements, lipids (e.g. Lipidem®/Lipoplus®), can be
added via the lipid additive port.
Nutriflex® 2-chamber bag (with and without Electrolytes available)
The steps:
Safety aspect
After adding the additives
to the clear solution, a
visual check is possible.
3-chamber bags
The 3-chamber bags provide different formulations and bag
volumes with amino acids, carbohydrates and fat and are
available with or without electrolytes.
On individual needs trace elements (e.g. Tracutil®) and other
micronutrients can be added via the additive port.
NuTRIflex® Lipid contains a MCT/LCT lipid emulsion.
NuTRIflex® Omega contains MCT/LCT/Omega-3-acid
triglycerides.
NuTRIflex® Lipid 3-chamber bag and NuTRIflex® Omega 3-chamber bag
(with and without Electrolytes available)
1. Remove the overwrap
and mix the upper left chamber
(Glucose) with the lower chamber (Amino Acid).
2. Then electrolytes, trace
elements and vitamins can be
added via the additive port (red
cap). Needles with the size of
0.8 -1.2 mm can be used.
3. Press the upper right
chamber (lipid emulsion) to
mix with the lower chamber.
Amino Acid
Lipid
Lipid: MCT/LCT
Omega: MCT/LCT/
Omega-3-acid
triglycerides
Glucose
Glucose
Amino Acid
4. Finally, mix thoroughly before inserting the giving set.
Port system
n
Low risk for needlestick injuries
n
Easy grip for convenient handling
n
No leakage after removal
n
Stable ports made of hard plastic
n
Self-sealing
8
User benefits
Latex-free
PVC-free
DEHP-free
Increased patient safety, through visual check
n
Environmental and patient-friendly bag material
(no PVC, no DEHP and no latex)
n
Convenient, cost-effective and safe
n
9
2-chamber bags
Nutriflex® – global portfolio overview*
Nutriflex®
Sterile solution for intravenous
nutrition containing amino
acids, carbohydrates and electrolytes in a 2-chamber bag.
Nutriflex®
Parenteral nutrition regimens for individual fat requirements
n
Flexibility in adding optional lipid emulsions such as
Lipoplus®1 or Lipofundin® MCT/LCT2
n
n
Different balanced regimens for peripheral and central
venous application
n
Reliable source of protein and calories
n
Supplies electrolytes
NuTRIflex® Lipid transfer set
Product range
Nutriflex® peri
n
Peripheral Parenteral Nutrition
n
Supplemented nutrition or in combination
with enteral feeding
n
For Low Glucose Nutrition (LGN) Therapy
Nutriflex® basal
n
Parenteral Nutrition in situations with basal
nutrition requirements
n
For central venous access
Nutriflex® plus
n
Parenteral Nutrition in situations with moderately
increased requirements
n
For central venous access
Nutriflex® special
n
Volume-restricted Parenteral Nutrition for ICU patients
n
In situations with high nutritional requirements
All Nutriflex® - 2-chamber bags
n
Flexibility to choose and add the fat component
(e.g. Lipoplus®1, Lipofundin® MCT/LCT2)
Additive port for lipids
(red cap)
Accessories
Nutriflex® Transfer Set (Art. No. 212 9043)
n
Light Protection Cover:
Nutriflex® 1000 ml (Art. No. 212 9035)
Nutriflex® 1500 ml, 2000 ml (Art. No. 211 2112)
n
Infusion port (white cap)
Additive port (red cap)
Nutriflex® 2-chamber bag
Volume (ml)
Composition
1000 ml
Nutriflex®
peri
Nutriflex®
basal
Nutriflex®
plus
Nutriflex®
special
Content
1. Trade name in some countries: Lipidem®
2. Trade name in some countries: Medialipide®, Vasolipid®
peri
basal
plus
1000
2000
1000
2000
1000
2000
1000
1500
Amino acids (g)
40
80
32
64
48.1
96.2
70
105
Nitrogen (g)
5.7
11.4
4.6
9.2
6.8
13.6
10
15
Glucose (g)
80
160
125
250
150
300
240
360
Total energy (kcal)
480
960
630
1255
790
1580
1240
1860
Osmolarity (mOsm/l)
900
900
1150
1150
1400
1400
2100
2100
Electrolytes (mmol)
Amino acids
g
40
32
48
70
Nitrogen*
g
5.7
4.6
6.8
10.0
Glucose
g
80
125
150
240
Calcium
2.5
5.0
3.6
7.2
+
+
+
+
Magnesium
4.0
8.0
5.7
11.4
480
630
790
1240
Phosphate
5.7
11.4
12.8
25.6
20.0
Electrolytes
special
Sodium
27
54
49.9
99.8
37.2
74.2
40.5
60.8
Potassium
15
30
30
60
25
50
25.7
38.6
3.6
7.2
4.1
6.2
5.7
11.4
5.0
7.5
40.0
14.7
22.1
Total energy
kcal
Non-Protein energy
kcal
320
500
600
960
Chloride
31.6
63.2
50
100
35.5
71
49.5
74.3
ml
1000, 2000
1000, 2000
1000, 2000
1000, 1500
Acetate
19.5
39
35
70
22.9
45.8
22
33
Presentations**
* due to the specific amino acid pattern, 14 g N ≈ 100 g amino acids; ** may differ from country to country
10
PLEASE NOTE: Additions to Nutriflex® may increase (e.g. electrolyte concentrates) or decrease (e.g. lipids) its osmolarity. Vitamins and trace elements should be added just prior to use!
There may be some degradation during shelf life. See manufacturer´s recommendation. *Not all versions and bag volumes will be marketed in each country.
11
3-chamber bags
NuTRIflex® Lipid – global portfolio overview*
NuTRIflex® Lipid
The right choice can be simple
NuTRIflex® Lipid represents a
wide range of 3-chamber bag
versions and sizes, covering
different patient needs from
mild to severe catabolism.
NuTRIflex® Lipid products contain MCT/LCT as lipid emulsion
and are availabel for peripheral
and central venous use with
and without electrolytes.
NuTRIflex® Lipid Special in a 625 ml bag
NuTRIflex® Lipid special 625 ml
- as ”ICU starter bag”
– for combined Enteral/Parenteral Nutrition
– as basic ”all-in-one” bag for children (>2 years)
n
n
n
n
n
Product range
NuTRIflex® Lipid peri
n
For peripheral or central venous access
n
Supplementary nutrition
n
In combination with Enteral Nutrition
n
Low glucose content
NuTRIflex® Lipid plus
n
Central venous Parenteral Nutrition for moderately
increased requirements
n
Easy to calculate: 1 ml ~ 1 kcal
NuTRIflex® Lipid special
n
If volume-restricted Parenteral Nutrition is required
n
In situations with high nutritional demands
n
625 ml version as ICU starter bag and for combined
Enteral/Parenteral Nutrition
NuTRIflex® Lipid special without electrolytes
n
For individualized electrolyte administration
NuTRIflex® Lipid peri
This unique size is suited for:
n
Patients requiring an incremental increase in Parenteral
Nutrition during their first days on ICU
n
In combination with Enteral Nutrition
n
Registered for the use in children from 2 to 13 years of age,
adolescents from 14 years of age and adults
1875 ml
1250 ml
Allows the simultaneous administration of required
nutrients out of one container
Contains MCT/LCT lipid emulsion
Electrolyte-containing versions cover the basic needs for
electrolytes and zinc
Electrolyte-free versions for individualized
electrolyte administration
Enteral Nutrition
Accessories
Light Protection Cover:
NuTRIflex® Lipid 1250 ml, 1875 ml, 2500 ml
(Art. No. 211 2112)
NuTRIflex® Lipid 625 ml (Art. No. 212 9035)
625 ml
n
NuTRIflex® Lipid 3-chamber bag
Volume (ml)
NuTRIflex® Lipid plus
without electrolytes
Content
Composition 1250 ml
2500 ml
NuTRIflex® Lipid
peri
1250
1875
plus
2500
1250
1875
special
a)
2500
625
1250
1875
2500
140.1
Amino acids (g)
40
60
80
48
72
96
35.1
70.1
105.1
Nitrogen (g)
5.7
8.6
11.4
6.8
10.2
13.6
5
10
15
20
Glucose (g)
80
120
160
150
225
300
90
180
270
360
Lipids (g)
50
75
100
50
75
100
25
50
75
100
Total energy (kcal)
955
1435
1910
1265
1900
2530
740
1475
2215
2950
Osmolarity (mOsm/l)
840
840
840
1215
1215
1215
1545
1545
1545
1545
134
Electrolytes (mmol)
Amino acids (g)
40
48
70.1
70.1
Sodium
50
75
100
50
75
100
33.5
67
100.5
Nitrogen* (g)
5.7
6.8
10
10
Potassium
30
45
60
35
52.5
70
23.5
47
70.5
94
Glucose (g)
80
150
180
180
Calcium
3.0
4.5
6.0
4.0
6.0
8.0
2.65
5.3
7.95
10.6
Lipids (MCT/LCT) (g)
50
50
50
50
Magnesium
3.0
4.5
6.0
4.0
6.0
8.0
2.65
5.3
7.95
10.6
Electrolytes
+
+
-
+
Phosphate
7.5
11.25
15.0
15.0
22.5
30.0
10.0
20.0
30.0
40.0
Total energy (kcal)
955
1265
1475
1475
Chloride
48
72
96
45
67.5
90
30
60
90
120
Non-Protein calories (kcal)
795
1075
1195
1195
Acetate
40
60
80
45
67.5
90
30
60
90
120
1250, 1875, 2500
1250, 1875, 2500
1250, 1875, 2500
625, 1250, 1875, 2500
0.03
0.045
0.06
0.03
0.045
0.06
0.02
0.04
0.06
0.08
Presentations** (ml)
* due to the specific amino acid pattern, 14 g N ≈ 100 g amino acids; ** may differ from country to country
12
Zinc
PLEASE NOTE: Additions to NuTRIflex® Lipid may increase its osmolarity. Vitamins and trace elements should be added just prior to use! There may be some degradation during shelf life. See manufacturer’s recommendation.
a)
NuTRIflex® Lipid special also exist as electrolyte-free version (special: 1330 mOsm/l). *Not all versions and bag volumes will be marketed in each country.
13
NuTRIflex® Omega
Simply Unique
Lipoplus®/Lipidem® vs. LCT
With electrolytes
Length of stay postoperative in hospital (LOS)
25
 Lipidem®/Lipoplus®
 LCT (soya oil emulsion)
*p < 0.006
20
Lipid
MCT/LCT/omega-3
*5 days
days
22
15
Glucose
17
10
Amino Acid
5
0
Modified from Wichmann et al. (2007)
NuTRIflex® Omega combines the benefits of Omega-3-acid triglycerides from fish oil
with the handling advantages of a 3-chamber bag.
Therapeutic Indications
NuTRIflex® Omega is indicated for the supply of energy and essential fatty acids including omega-3 and omega-6 fatty acids,
amino acids, electrolytes and fluids in the setting of Parenteral
Nutrition of patients in states of moderate to severe catabolism
when oral or Enteral Nutrition is impossible, insufficient or contraindicated1.
No Limit
The duration of treatment for the indications stated is not
limited. During long-term administration of NuTRIflex® Omega
it is necessary to provide for appropriate replacement of trace
elements and vitamins 1.
Fatty acid
EPA
DHA
NuTRIflex®
Omega plus
NuTRIflex®
Omega plus
NuTRIflex®
Omega special
NuTRIflex®
Omega special
NuTRIflex®
Omega special
NuTRIflex®
Omega special
Vol
ml
1,250
1,875
2,500
625
1,250
1,875
2,500
Total energy
kcal
1,265
1,900
2,530
740
1,475
2,215
2,950
Total energy
kJ
5,300
7,950
10,600
3,095
6,175
9,265
12,350
140.1
Notation
Lipoplus® 20 %
Competitor
20
20:5n3
3.69 ± 0.14
3.03 ± 0.12
Amino acids
g
48
72
96
35.1
70.1
105.1
22:6n3
2.53 ± 0.14
2.00 ± 0.15
Nitrogen
g
6.8
10.2
13.6
5
10
15
20
Glucose
g
150
225
300
90
180
270
360
Medium chain
triglycerides
g
25
37.5
50
12.5
25
37.5
50
Soya-bean oil
g
20
30
40
10
20
30
40
Omega-3 acid
triglycerides
g
5
7.5
10
2.5
5
7.5
10
mmol
50
75
100
33.5
67
100.5
134
22
Reduced length of stay
The lipid component (Lipoplus®/Lipidem®) shows a positive
treatment effect reflected in a reduced length of hospital stay 3,4.
Electrolytes:
Sodium (Na+)
Benefits
Potassium (K )
mmol
35
52.5
70
23.5
47
70.5
94
Magnesium (Mg2+)
mmol
4
6
8
2.65
5.3
7.95
10.6
No limit in duration of treatment 1
nLipid component is rich in EPA and DHA 2
nImproved lung function 3
nReduced length of hospital stay 3,4
Calcium (Ca2+)
mmol
4
6
8
2.65
5.3
7.95
10.6
Phosphat
mmol
15
22.5
30
10
20
30
40
Chloride (Cl-)
mmol
45
67.5
90
30
60
90
120
n
1
SmPC NuTRIflex® Omega, Status of latest information: February 2013
Driscoll D F et al. Int J Pharm 2009 Sep 8;379 (1):125-30
Barbosa VM et al. Crit Care. 2010;14(1):R5. Epub 2010 Jan 19
4
Wichmann MW et al. Crit Care Med. 2007 Mar; 35 (3):700-6
2
14
NuTRIflex®
Omega plus
Carbon
Fatty acid profiles expressed as weight percent (wt%) from
total lipids (20 g/100 mL). Modified from Driscoll et al. (2009)
Rich in EPA and DHA
Both eicosapentaenoic acid (EPA, C20:5[omega-3] and docosahexaenoic acid (DHA,C22:6[omega-3]) are fundamentally important fatty acids and known factors which influence the pattern
of inflammation-regulating eicosanoids and other cytokines.
The lipid component (Lipoplus®/Lipidem®) in NuTRIflex® Omega
shows a high content of EPA and DHA2.
[unit]
3
+
Acetate
mmol
45
67.5
90
30
60
90
120
Zinc (Zn2+)
mmol
0.03
0.05
0.06
0.02
0.04
0.06
0.08
Antioxidant:
Additional Vitamin E approx. 200 mg a-tocopherol/L inside!
15
The single bottle system …
Patient-tailored regimens
Critically ill, significantly catabolic, malnourished patients with
compromised metabolic and organ functions (e.g. liver or renal
insufficient patients) sometimes require patient-tailored TPN
because their nutrient requirements are specific and tend to vary
significantly from patient to patient and during each patient's
hospital stay.
… for Parenteral Nutrition
Against this background, the NuTRIflex® System allows hospital
compounding services to focus on those 10%–20% critically ill
patients requiring patient-tailored nutrition support.
Traditionally, this kind of nutrition therapy is prepared at the
hospital pharmacy by compounding the different required components into one mixing bag. This procedure is time-consuming
and requires extensive technical equipment and pharmaceutical
know-how.
Compounding of a
Nutrimix® mixing bag
Product range
nAminoplasmal® B. Braun:
Amino acid solutions for Parenteral Nutrition
nAminoplasmal® Hepa:
Amino acid solution for Parenteral Nutrition in severe
liver disease and for the therapy of hepatic encephalopathy
Lipoplus®/Lipidem®:
Modern fat emulsion based on medium and long
chain triglycerides including -3 fatty acids
n
Lipofundin® MCT/LCT 1:
Fat emulsion on the basis of medium and
long chain triglycerides
n
Glucose Braun: Glucose solution for providing energy
n
Tracutil®: Trace element additive
n
Nutrimix®: EVA mixing bags
n
User benefits
Wide range of products
n
Selection of products according to individual
patient requirements
n
16
17
Amino acids
Lipid emulsions
Aminoplasmal® B. Braun
Amino acid solution for
Parenteral Nutrition.
Aminoplasmal® Hepa 10%
Amino acid solution for
Parenteral Nutrition for
patients with severe liver
diseases and for treatment
of hepatic encephalopathy.
Lipofundin® MCT/LCT 1
Fat emulsion for Parenteral
Nutrition on the basis of
medium and long chain
triglycerides.
Lipoplus® 15
New generation of lipid
emulsion.
In addition to the well known
characteristics of Lipofundin®
MCT/LCT 1, Lipoplus® 15 has a
well-balanced 3 : 6 ratio
of 1: 2.7, achieved by adding
highly purified -3 acid
triglycerides.
Administration of LCT as source
of essential (polyunsaturated)
fatty acids for structural components of cell membranes and
as precursors of eicosanoids.
MCT as preferential fuel for the
body with physicochemical and
metabolic advantages.
Aminoplasmal®
Aminoplasmal® Hepa
Balanced supply of essential and nonessential amino acids
n
Lipofundin® MCT/LCT1
Normalization of cirrhosis-induced amino acid imbalances1,2
n
Improved clinical situation in hepatic encephalopathy2
n
Achievement of nitrogen balance in cirrhotics2
n
n
Amino acid pattern for children above 2 years of age
and for adults
n
n
Lipoplus®15
Protects liver, lung and immune function2,3,4,5,6,7,8
Improves protein economy9,10
Inflammation-modulating effects
- reduced length of hospital stay16,17
- improved oxygenation index17
n
Superior stability improves safety11,12
n
Antioxidative protection to prevent peroxidative damages13
n
Characteristics
n
Flexible through concentration range of 5-15%
n
Available with and without electrolytes
n
Electrolyte-free versions chloride-free
Characteristics
n
Amino acid concentration of 10%
n
Amino acid pattern adapted to the specific needs of patients
with severe liver insufficiency2
1. Leweling H. et al., Aminosäuren- und Ammoniakstoffwechsel bei Leberinsuffizienz,
Witzstrock 1982: 193-202®
2. Leweling H. et al., Aminosäurentransferlösungen, Klinische Ernährung 1985 /15): 316-332
Amino acids
g
50
10%
10 % E
100
100
Nitrogen
g
8
16
Composition
1000 ml
5% E
Electrolytes
Energy
Presentations*
* may differ from country to country
18
+
-
+
Aminoplasmal®
15 %
15 % E
150
150
Aminoplasmal®
Hepa 10 %
24
15.3
-
+
100
-
kcal
200
400
600
400
ml
250, 500, 1000
250, 500, 1000
500, 1000
500
Characteristics
n
Registered for use in neonates and children
n
For peripheral and central venous application
n
Excellent stability in TPN admixtures14
1. Trade name in some countries: Medialipide®,
Vasolipid®
2. Baldermann H. et al. Changes of hepatic morphology during paterteral nutrition with lipid emulsions
containing LCT or MCT/LCT quantifies by ultrasound;
JPEN 1991; 15: 601-603
3. Carpentier YA, et al. Long-term TPN and liver
dysfunction; Clinical Nutrition 8 (1989) 31, special
supplement
4. Kuse ER. et al. Hepatic reticuloendothelial function
during parenteral nutrition including an MCT/LCT or
LCT emulsion after liver transplantation - a doubleblind study; Transpl Int 15 (2002) 272-277
5. Radermacher P. et al. Fat emulsions containing
medium chain triglycerides in patients with sepsis
syndrome: effects on pulmonary hemodynamics and
gas exchange; Intensive Care Med 18 (1992) 231-234
6. Fiaccadori E, et al. Hemodynamic and respiratory
effects of medium-chain and long chain triglyceride
fat emulsions: a prospective, randomized study;
RINPE 15 (1997) 6-14
7. Gelas Pet al. Effect of parenteral medium and longchain triglycerides on lymphocytes subpopulations
and functions in patients with acquired immunodeficiency syndrome: a prospective study; JPEN 22
(1998) 67-71
8. Sedman PC. et al. Effects of different lipid emulsions on lymphocyte function during total parenteral nutrition; Br J Surg 78 (1991) 1396-1399
9. Dennison AR, et al. Total parenteral nutrition using
conventional and medium-chain triglycerides:
effects on liver function tests, complement, and
nitrogen balance; JPEN 12 (1988) 15-19
10. Lai HS and Chen WJ Effects of medium and longchain triacylglycerols in pediatric surgical patients;
Nutrition 16 (2000) 401-406
11. Driscoll DF et al. Physicochemical stability of two
types of intravenous lipid emulsion as total parenteral nutrient admixtures; JPEN 24 (2000) 15-22
12.Driscoll DF, et al. The influence of medium-chain
triglycerides on the stability of all-in-one formulations; Int J Pharm 240 (2002) 1-10
13.Arborati M et al. Comparison of lipoperoxide content
and lipoperoxidability in parenteral fat emulsions
with different triglyceride composition; Clinical
Nutrition 16 (1997) 5, supplement 2
14.Driscoll DF et al., Establishing an stability window
for medium- and long-chain-triglyceride lipidbased total nutrient admixtures using USP standards; A m J Health-Syst Pharm 2006; 63: 2135-43
15.Trade name in some countries: Lipidem®
16.Wichmann et al. Crit Care Med 2007; 35, 700-706
17.Barbosa VM et al. Crit Care. 2010;14(1):R5.
Epub 2010 Jan 19
18.Driscoll DF, Clinical Nutrition 2001 (20)
Supplement 4: 8-10
Characteristics
n
Contains MCT (coconut), LCT (soybean) and -3 acid triglycerides
n
For peripheral and central venous application
n
Excellent stability in all-in-one admixtures18
n
The combination with Nutriflex® 2-chamber bag allows quick,
easy and stable preparation of all-in-one regimens
Lipofundin® Lipoplus®  20% or
Lipofundin®
MCT/LCT 1 10% MCT/LCT 1 20%
Lipidem®20%
Composition 1000 ml
Soybean oil (LCT)
g
50
100
80
MCT oil (coconut)
g
50
100
100
Omega-3 acid triglycerides
g
–
–
20
Egg yolk lecithin
g
8
12
12
Glycerol
g
25
25
25
Total energy
kcal
1022
1908
1910
a-Tocopherol (Vitamin E)
mg
85 ± 20
170 ± 40
190 ± 30
Presentations*
ml 100, 250, 500
100, 250, 500
100, 250, 500
19
Glucose solutions and trace elements
Mixing bag
Glucose Braun
Glucose solutions for providing
energy (and fluid)
in Parenteral Nutrition.
Nutrimix®
Traditional EVA mixing bag for easy and
safe handling.
Tracutil®
Trace element additive for
adults. Used as a supplement
in Parenteral Nutrition.
Nutrimix® Barrier
Mixing Bag made of Multi-Layer Film to
protect individual TPN preparations from
oxidation.
Nutrimix®
Nutrimix® Barrier
100% Latex-free and DEHP-free,
specially suitable for fat-containing TPN regimens
Glucose Braun
Tracutil®
Essential energy source for organs and tissues
� Additive injection port with
closure cap
Prolongs the stability of oxygensensitive compounds (e.g. vitamins)
�
Supply of trace elements in Parenteral Nutrition of adults
�
Nutrimix® DC
100% Latex-free and DEHP-free,
specially suitable for fat-containing
TPN regimens
�
� � Detachable transfer set with lock
connector
Ensures longer shelf life of
compounded regimens
� Compatible with a wide range of nutritional admixtures
� � Sterile outlet port with snap-off
cap
Sterile outlet port with snap-off
cap ensures easy and safe handling
� � Easy and safe handling
�
Characteristics
n
Basic component in Parenteral Nutrition
n
Delivers approximately 4 kcal/g glucose
n
Wide range of concentrations available
Composition®
1000 ml
Glucose Energy
Characteristics
n
Balanced mixture of the 9 trace elements Iron, Zinc, Manganese, Copper, Chromium, Molybdenum, Selenium, Fluoride and Iodide
n
Meets the daily requirements of essential trace elements
Glucose
g
10%
100
20%
200
30%
300
40%
400
50%
500
70 %
700
kcal
400
800
1200
1600
2000
2800
Presentations*
Ecoflac® plus 500 ml; glass bottle 500 ml/1000 ml
Composition®
Tracutil
Iron
µmol/10 ml
2
35
Zinc
3.3
50
Manganese
0.55
10
Copper
0.76
12
Chromium
0.01
0.2
Molybdenum
0.01
0.1
Selenium
0.02
0.3
Fluoride
0.57
30
Iodide
0.13
1
Presentation*
20
mg/10 ml
5 x 10 Ampoule
Nutrimix® DC
Dual chamber bag
for stable separate
storage of individual TPN preparation.
100%-Latex free and DEHP-free,
specially suitable for fat-containing
TPN regimens
� Dual chamber allows preparation
with separate storage e.g. of amino
acid-glucose mixture separate from
lipid emulsion and therefore longer
storage of compounded lipid-containing TPN formulations
� High flow filling port
� Sterile outlet port with snap-off cap
to ensure easy and safe handling
� Presentations*
Volume
Filling lines
Units/Packages
Packages/Carton
Code No. (REF)
Nutrimix® 0.2/0
200 ml
0
1
25
2112145
Nutrimix® 0.5/0
500 ml
0
1
25
2112146
Nutrimix® 1/0
1000 ml
0
1
25
2112147
Nutrimix® 2/3
2000 ml
3
1
25
2112150
Nutrimix® 3/3
3000 ml
3
1
25
2112151
Nutrimix® Barrier 3/0
3000 ml
0
5
25
2112444
2000 ml
0
5
25
2112443
1000 ml
0
5
40
2112442
Nutrimix® Barrier 0,5/0
500 ml
0
5
50
2112441
Nutrimix® Barrier 0,2/0
200 ml
0
5
50
2112440
25
2112446
25
2112445
25
2112449
Nutrimix® Dual Chamber Bags
(2500 + 500 ml)
3000 ml
0
Nutrimix® Dual Chamber Bags
(1250 + 250 ml)
1500 ml
0
0
4
Transfer Set
1
1
1
21
Enteral Nutrition
Enteral Nutrition Diets
Nutricomp® Standard and Disease Specific
BCAA
Rich in BCAA
Carbohydrates
Lipids
Rich in MUFA
Rich in protein
Rich in oligopeptides
Low in carbohydrates
Rich in fish oil
With fiber
Rich in glutamine
Lactose free
Complex carbohydrates
Normocaloric (1.0 kcal / ml)
Protein
1.3
High-caloric (1.3 kcal / ml)
1.5
Glu
Nutricomp® Standard Diets
Normal energy needs
MCT
Rich in MCT
Nutricomp® Disease Specific Diets
High energy & protein needs
Normal energy needs
Normal energy needs
High energy needs
Impaired immune
function
n Metabolic stress
n Consuming diseases
n Inflammatory diseases
n Post-operative
Anorexia
Convalescence
nLoss of conciousness
Anorexia
Convalescence
n Loss of conciousness
n
n
n
n
Key Features
Key Indications
n
Fluid restrictions
n Chronic wasting
diseases
n Surgery
n
Fluid restrictions
n Chronic wasting
diseases
n Surgery
n
Maldigestion
n Malabsorption
n Pancreas failure
n Jejunal feeding
Impaired lipid
digestion
n Fat malabsorption
n Steatorrhea
n
n
Glucose intolerance
n
Milk protein
intolerance
Milk protein
intolerance
n
n
1.5
1.5
10 x
R
1.3
H2N
Impaired liver
function
n Liver disease
1.3
MCT
Posttraumatic
metabolic condition
n Respiratory failure
n
n
1.3
Glu
BCAA
1.3
MCT
MCT
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
g / 1000 ml
% Energy
Protein
38
15
38
15
75
20
75
20
41
16
38
14
39
15
39
16
56
17
66
20
40
12
65
20
Fat
33
30
33
29
50
30
50
29
35
32
11
12
133
54
133
52
44
30
37
24
58
40
58
40
Carboh.
138
55
138
53
188
50
188
48
123
48
188
74
35
31
35
30
170
53
183
54
155
48
130
40
-
0
15
3
-
0
20
3
21
4
-
0
-
0
15
2
< 0.1
0
13
2
<6
0
<1
0
Fiber
Water
22
840 ml
830 ml
760 ml
750 ml
830 ml
840 ml
840 ml
830 ml
790 ml
780 ml
800 ml
790 ml
23
Enteral Nutrition
Nutricomp® Enteral Nutrition ...
... with ENPlus Safety System
Nutricomp® - composed for enteral feeding
New Safety for Nutricomp® Bags with ENPlus
Enteral Nutrition Diets
Are used when the nutritional requirements of a patient can
not be met by oral intake alone. Enteral Nutrition diets, such
as Nutricomp®, can be used to supplement a diet or as a sole
source of nutrition for patients with existing malnutrition or at
risk of malnutrition. Nutricomp® can be taken orally or administered via nasogastric, gastrostomy or jejunostomy tubes.
Composition of Nutricomp®
Standard diets of Nutricomp® are polymeric formulas that
contain intact nutrients of high molecular weight (polymeric
proteins, polysaccharides and triglycerides) and correspond
nutritionally to a normal diet. Nutricomp® formulas can also
be disease specific adapted whereby the macro- and micronutrients are composed to meet the needs of patients with this
specific underlying disease or digestive metabolic disorder.
Recommended Daily Dosage of Nutricomp®
The recommended daily dosage of Nutricomp® depends on the
patient requirements and should be tailored to the patient's
specific nutritional needs.
Nutricomp® diets are complete formulas and cover the recommended daily requirements for all nutrients, such as
protein, lipids, carbohydrates, fiber, vitamins, trace elements
and electrolytes.
Nutricomp® Bag: now with the purple ENPlus Port
B. Braun is dedicated to making the administration of Enteral
and Parenteral Nutrition safer. Our new Safety System for the
Nutricomp® bag eliminates confusion between Enteral and
Parenteral routes through the introduction of the ENPlus Port.
This port is dedicated to the application of Enteral Nutrition as
it only connects to Enteral Nutrition administration sets following a lock and key model. Intravenous application sets will not
be able to connect to the ENPlus Port.
Safe & Simple
User benefits
ENPlus Port is a dedicated Enteral
Nutrition port that avoids the connection to Parenteral or intravenous
application sets
n
Purple color coded for faster
identification
n
Nutricomp® formulas provide the recommended daily requirements of all nutrients by a daily intake of approximately 1500
kcal.
The Nutricomp® bag with ENPlus Port is connectable to the
Multispike or ENPlus Spike for all Enteral Nutrition administration ways. Whether you are using…
Gravity Systems (e. g. Nutrifix®)
One system for all Enteral Nutrition
application ways
n
B. Braun‘s ambulatory EN pump for administration
(Enteroport® plus)
or B. Braun‘s universal pump for administration
(B. Braun Space)
Hanger
Nutricomp Standard & Disease Specific Diets
®
Special
ingredients
Easy opening of
innovative peel seam
Compatibility to all
administration sets
with ENPlus Spike,
Multispike or
Universal Adapter
24
25
Nutricomp® Standard
Enteral Nutrition
Product Description
Nutricomp® Standard is a normocaloric, nutritionally complete dietary food, enriched
with fish oil, for special medical purposes. It can be used for sip or tube feeding.
n
n
n
n
High biologic value protein from different protein sources such as casein and soy
Balanced fatty-acid profile from the combination of soy oil, MCT and fish oil
Carbohydrate composition from maltodextrin to provide a rapid and easily
available energy source
Low, physiological osmolarity / osmolality for better compliance:
n Osmolarity: 200 mosmol / Osmolality: 240 mosmol / kg
Indications (examples)
n Normal energy needs
n Contraindications to fiber
Nutrition information (neutral flavor)
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
100 kcal / 421 kJ
500 kcal / 2105 kJ
Vitamin A
90 µg
450 µg
Protein
3.8 g
19 g
Vitamin D
1 µg
5 µg
Fat
3.3 g
16.5 g
Vitamin E
1.5 mg
7.5 mg
13.8 g
69 g
Vitamin K
7 µg
35 µg
-
-
Vitamin B1
0.2 mg
1 mg
84 ml
420 ml
Vitamin B2
0.2 mg
1 mg
Vitamin B6
0.2 mg
1 mg
Vitamin B12
0.3 µg
1.5 µg
Vitamin C
10 mg
50 mg
1.8 mg
9 mg
30 μg
150 μg
0.6 mg
3 mg
5 μg
25 μg
Carbohydrates
Fiber
Safety System characteristic
Bag with purple colored ENPlus Port
n Compatible to all administration systems with ENPlus Spike, Multispike or
Universal Adapter
n
Water
Minerals
Normocaloric
(1.0 kcal)
100 mg
500 mg
Potassium (K)
150 mg
650 mg
Calcium (Ca)
75 mg
375 mg
Niacin
Magnesium (Mg)
20 mg
100 mg
Folic acid
Phosphorus (P)
65 mg
325 mg
Pantothenic acid
100 mg
500 mg
Biotin
Rich in fish oil
Trace Elements
per
100 ml
per
500 ml
Iron (Fe)
1.2 mg
6 mg
Zinc (Zn)
1.2 mg
6 mg
Copper (Cu)
150 µg
750 µg
13 µg
65 µg
7 µg
35 µg
Iodine (I)
n
High amount of fish oil (EPA + DHA: 0.05 g / 100 ml)
n
15 % of MCT (0.5 g / 100 ml) to facilitate absorption
Chromium (Cr)
n
Contains beta-carotene (0.1 mg / 100 ml)
Manganese (Mn)
0.2 mg
1 mg
n
Gluten, lactose and cholesterol free, strictly low in purine
Molybdenum (Mo)
10 µg
50 µg
7 µg
35 µg
Selenium (Se)
26
per
500 ml
Sodium (Na)
Chloride (Cl)
Special features
per
100 ml
per
100 ml
15 %
30 %
55 %
0%
per
500 ml
27
Enteral Nutrition
n
n
n
n
n
Balanced fatty-acid profile from the combination of soy oil, rape seed oil, MCT
and fish oil
Carbohydrate composition from maltodextrin and resistant starch to provide
a rapid and easily available energy source
Fiber sources from inulin, oat and resistant starch
Low, physiological osmolarity/ osmolality for better compliance:
n Regulation of bowel function
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
104 kcal / 437 kJ
500 kcal / 2185 kJ
Vitamin A
90 µg
450 µg
Protein
3.8 g
19 g
Vitamin D
1 µg
5 µg
Fat
3.3 g
16.5 g
Vitamin E
1.5 mg
7.5 mg
13.8 g
69 g
Vitamin K
7 µg
35 µg
Fiber
1.5 g
7.5 g
Vitamin B1
0.2 mg
1 mg
Water
83 ml
415 ml
Vitamin B2
0.2 mg
1 mg
Vitamin B6
0.2 mg
1 mg
Vitamin B12
0.3 µg
1.5 µg
Vitamin C
10 mg
50 mg
1.8 mg
9 mg
30 μg
150 μg
0.6 mg
3 mg
5 μg
25 μg
Carbohydrates
n Bag with purple colored ENPlus Port
Universal Adapter
Normocaloric
(1.0 kcal)
Minerals
100 mg
500 mg
Potassium (K)
150 mg
750 mg
Calcium (Ca)
75 mg
375 mg
Niacin
Magnesium (Mg)
20 mg
100 mg
Folic acid
Phosphorus (P)
65 mg
325 mg
Pantothenic acid
100 mg
500 mg
Biotin
Rich in fish oil
Trace Elements
Special features
6 mg
Zinc (Zn)
1.2 mg
6 mg
Copper (Cu)
150 µg
750 µg
13 µg
65 µg
7 µg
35 µg
Manganese (Mn)
0.2 mg
1 mg
Molybdenum (Mo)
10 µg
50 µg
7 µg
35 µg
n
Iodine (I)
Prebiotic fiber composition providing both soluble (60 %) and
insoluble (40 %) fiber
Chromium (Cr)
n
Selenium (Se)
28
per
500 ml
1.2 mg
n
per
100 ml
Iron (Fe)
n
n
per
500 ml
Sodium (Na)
Chloride (Cl)
Rich in fiber
per
100 ml
per
100 ml
15 %
29 %
53 %
3%
per
500 ml
Nutricomp® Standard Fibre
Product Description
Nutricomp® Standard Fibre is a normocaloric, nutritionally complete dietary food,
enriched with fish oil, for special medical purposes. It can be used for sip or tube
feeding.
29
Enteral Nutrition
n
n
n
n
Balanced fatty-acid profile from the combination of rape seed oil, MCT and fish oil
n High energy needs
n High protein needs
n Fluid restrictions
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
150 kcal / 632 kJ
750 kcal / 3160 kJ
Vitamin A
135 µg
675 µg
Protein
7.5 g
37.5 g
Vitamin D
1.5 µg
7.5 µg
5g
25 g
Vitamin E
3 mg
15 mg
18.8 g
94 g
Vitamin K
11 µg
55 µg
-
-
Vitamin B1
0.3 mg
1.5 mg
76 ml
380 ml
Vitamin B2
0.3 mg
1.5 mg
Vitamin B6
0.3 mg
1.5 mg
Vitamin B12
0.45 µg
2.25 µg
Vitamin C
15 mg
75 mg
2.7 mg
13.5 mg
45 μg
225 μg
Fat
Carbohydrates
Fiber
Water
Universal Adapter
n
1.5
High-caloric
(1.5 kcal)
Minerals
150 mg
750 mg
Potassium (K)
225 mg
1125 mg
Calcium (Ca)
112 mg
560 mg
Niacin
Magnesium (Mg)
30 mg
150 mg
Folic acid
Phosphorus (P)
98 mg
490 mg
Pantothenic acid
0.9 mg
4.5 mg
150 mg
750 mg
Biotin
7.5 μg
37.5 μg
Rich in fish oil
Trace Elements
Special features
30
per
500 ml
per
500 ml
Sodium (Na)
Chloride (Cl)
Rich in protein
per
100 ml
per
100 ml
per
100 ml
per
500 ml
Iron (Fe)
1.8 mg
9 mg
Zinc (Zn)
1.8 mg
9 mg
Copper (Cu)
225 µg
1125 µg
n
Iodine (I)
20 µg
100 µg
n
Chromium (Cr)
11 µg
55 µg
n
High amount of protein (7.5 g / 100 ml)
Manganese (Mn)
0.3 mg
1.5 mg
n
Molybdenum (Mo)
15 µg
75 µg
n
Gluten and cholesterol free, strictly low in lactose and purine
Selenium (Se)
11 µg
55 µg
20 %
30 %
50 %
0%
Nutricomp® Energy
Product Description
Nutricomp® Energy is a high-caloric, nutritionally complete dietary food, enriched
with fish oil, for special medical purposes. It can be used for sip or tube feeding.
31
Enteral Nutrition
n
n
n
n
n
Balanced fatty-acid profile from the combination of MCT, rape seed oil and fish oil
Carbohydrate composition from maltodextrin and resistant starch to provide
a rapid and easily available energy source
Fiber sources from inulin, resistant starch, cellulose and wheat dextrin
n High energy and protein needs
n Fluid restrictions
n Regulation of bowel function
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
156 kcal / 655 kJ
780 kcal / 3275 kJ
Vitamin A
135 µg
675 µg
Protein
7.5 g
37.5 g
Vitamin D
1.5 µg
7.5 µg
5g
25 g
Vitamin E
3 mg
15 mg
18.8 g
94 g
Vitamin K
11 µg
55 µg
2g
10 g
Vitamin B1
0.3 mg
1.5 mg
75 ml
375 ml
Vitamin B2
0.3 mg
1.5 mg
Vitamin B6
0.3 mg
1.5 mg
Vitamin B12
0.45 µg
2.25 µg
Vitamin C
15 mg
75 mg
2.7 mg
13.5 mg
45 μg
225 μg
Fat
Carbohydrates
Fiber
Water
Universal Adapter
n
1.5
High-caloric
(1.5 kcal)
Minerals
150 mg
750 mg
Potassium (K)
225 mg
1125 mg
Calcium (Ca)
112 mg
560 mg
Niacin
Magnesium (Mg)
30 mg
150 mg
Folic acid
Phosphorus (P)
98 mg
490 mg
Pantothenic acid
0.9 mg
4.5 mg
150 mg
750 mg
Biotin
7.5 μg
37.5 μg
Rich in fish oil
Trace Elements
Rich in fiber
Rich in protein
32
n
n
n
n
n
n
Gluten free, low in cholesterol, strictly low in lactose and purine
per
500 ml
per
500 ml
Sodium (Na)
Chloride (Cl)
Special features
per
100 ml
per
100 ml
per
100 ml
per
500 ml
Iron (Fe)
1.8 mg
9 mg
Zinc (Zn)
1.8 mg
9 mg
Copper (Cu)
225 µg
1125 µg
Iodine (I)
20 µg
100 µg
Chromium (Cr)
11 µg
55 µg
Manganese (Mn)
0.3 mg
1.5 mg
Molybdenum (Mo)
15 µg
75 µg
Selenium (Se)
11 µg
55 µg
20 %
29 %
48 %
3%
Nutricomp® Energy Fibre
Product Description
Nutricomp® Energy Fibre is a high-caloric, nutritionally complete dietary food,
enriched with fish oil, for special medical purposes.
33
Nutricomp® Disease Specific Diets
Product Description
Nutricomp® Standard Fibre D is a normocaloric, nutritionally complete dietary food,
enriched with fish oil, for special medical purposes. It can be used for sip or tube
feeding.
n
n
n
n
n
Balanced fatty-acid profile from the combination of sunflower oil, fish oil and
rape seed oil
Carbohydrate composition from tapioca starch
Fiber sources from inulin, soy, resistant starch, cellulose and wheat
n Glucose intolerance
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
103 kcal / 432 kJ
515kcal / 2160 kJ
Vitamin A
90 µg
450 µg
Protein
4.1 g
20.5 g
Vitamin D
1 µg
5 µg
Fat
3.5 g
17.5 g
Vitamin E
1.5 mg
7.5 mg
12.3 g
61.5 g
Vitamin K
7 µg
35 µg
Fiber
2.1 g
22.05 g
Vitamin B1
0.2 mg
1 mg
Water
83 ml
415 ml
Vitamin B2
0.2 mg
1 mg
Vitamin B6
0.2 mg
1 mg
Vitamin B12
0.3 µg
1.5 µg
Vitamin C
10 mg
50 mg
1.8 mg
9 mg
30 μg
150 μg
0.6 mg
3 mg
5 μg
25 μg
Carbohydrates
Universal Adapter
n
Normocaloric
(1.0 kcal)
Minerals
100 mg
500 mg
Potassium (K)
150 mg
750 mg
Calcium (Ca)
75 mg
375 mg
Niacin
Magnesium (Mg)
20 mg
100 mg
Folic acid
Phosphorus (P)
65 mg
325 mg
Pantothenic acid
100 mg
500 mg
Biotin
Rich in fish oil
Rich in fiber
Rich in MUFA
Complex
carbohydrates
34
per
500 ml
Sodium (Na)
Chloride (Cl)
Special features
per
100 ml
Trace Elements
per
100 ml
per
500 ml
Iron (Fe)
1.2 mg
6 mg
62 % of MUFA (2.2 g / 100 ml)
Zinc (Zn)
1.2 mg
6 mg
n
High supply of complex carbohydrates (95 % tapioca starch)
Copper (Cu)
150 µg
750 µg
n
Very low in fructose
Iodine (I)
13 µg
65 µg
Chromium (Cr)
10 µg
50 µg
n
Manganese (Mn)
0.2 mg
1 mg
n
Rich in antioxidants
Molybdenum (Mo)
10 µg
100 µg
n
Selenium (Se)
7 µg
35 µg
n
n
n
per
100 ml
16 %
31 %
49 %
4%
per
500 ml
35
Nutricomp® D
Enteral Nutrition
Enteral Nutrition
per
100 ml
per
500 ml
Vitamins
Energy
100 kcal / 424 kJ
500 kcal / 2120 kJ
Vitamin A
50 µg
250 µg
Protein
3.8 g
19 g
Vitamin D
0.5 µg
2.5 µg
Fat
1.1 g
5.5 g
Vitamin E
0.7 mg
3.5 mg
18.8 g
94 g
Vitamin K
4.5 µg
22.5 µg
Fiber
< 0.3 g
< 1.5 g
Vitamin B1
0.1 mg
0.5 mg
n Malassimilation syndrome (malabsorption and maldigestion)
n Pancreas failure
n Jejunal feeding
Water
84 ml
420 ml
Vitamin B2
0.1 mg
0.5 mg
Vitamin B6
0.1 mg
0.5 mg
Universal Adapter
Sodium (Na)
140 mg
700 mg
Vitamin B12
0.3 µg
1.5 µg
Potassium (K)
120 mg
600 mg
Vitamin C
4.5 mg
22.5 mg
Calcium (Ca)
50 mg
250 mg
Niacin
1.2 mg
6 mg
Magnesium (Mg)
18 mg
90 mg
20 μg
100 μg
Phosphorus (P)
40 mg
200 mg
Pantothenic acid
0.51 mg
3.55 mg
Chloride (Cl)
96 mg
480 mg
Biotin
5 μg
25 μg
n
n
n
n
High biologic value protein from different protein sources such as whey protein
and soy hydrolysate
Balanced fatty-acid profile from the combination of MCT and soy oil
Key
characteristics
Carbohydrates
Normocaloric
(1.0 kcal)
Rich in
oligopeptides
Minerals
Trace Elements
36
per
100 ml
per
500 ml
per
500 ml
Iron (Fe)
0.9 mg
4.5 mg
Zinc (Zn)
0.75 mg
3.75 mg
100 µg
500 µg
13 µg
65 µg
5 µg
25 µg
0.15 mg
0.75 mg
Copper (Cu)
Special features
per
100 ml
Iodine (I)
Chromium (Cr)
n
Protein as defined oligopeptides (molecular weight < 1 kDa = 83 %)
n
Low amount of fat (12 % of total energy)
Manganese (Mn)
n
Molybdenum (Mo)
10 µg
50 µg
n
Gluten and cholesterol free, strictly low in lactose
Selenium (Se)
5.7 µg
28.5 µg
per
100 ml
Folic acid
14 %
12 %
74 %
0%
per
500 ml
Nutricomp® Peptid
Product Description
Nutricomp® Peptid is a normocaloric, nutritionally complete dietary food, with
protein as defined oligopeptides, for special medical purposes. It can be used for
sip or tube feeding and comes with a slight taste of peppermint.
37
Enteral Nutrition
n
n
n
n
High biologic value protein from soy protein only
Balanced fatty-acid profile from the combination of rape seed oil,
soy oil and fish oil
Carbohydrate composition from maltodextrin
n Milk protein intolerance
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
101 kcal / 423 kJ
505 kcal / 2115 kJ
Vitamin A
90 µg
450 µg
Protein
3.9 g
19.5 g
Vitamin D
1 µg
5 µg
Fat
3.5 g
17.5 g
Vitamin E
1.5 mg
7.5 mg
13.3 g
66.5 g
Vitamin K
7 µg
35 µg
-
-
Vitamin B1
0.2 mg
1 mg
84 ml
420 ml
Vitamin B2
0.2 mg
1 mg
Vitamin B6
0.2 mg
1 mg
Vitamin B12
0.3 µg
1.5 µg
Vitamin C
10 mg
50 mg
1.8 mg
9 mg
30 μg
150 μg
0.6 mg
3 mg
5 μg
25 μg
Carbohydrates
Fiber
Water
Universal Adapter
n
Normocaloric
(1.0 kcal)
Minerals
80 mg
400 mg
Potassium (K)
133 mg
665 mg
Calcium (Ca)
67 mg
336 mg
Niacin
Magnesium (Mg)
24 mg
120 mg
Folic acid
Phosphorus (P)
50 mg
250 mg
Pantothenic acid
100 mg
500 mg
Biotin
Rich in fish oil
Trace Elements
Special features
per
100 ml
per
500 ml
Iron (Fe)
1.2 mg
6 mg
Zinc (Zn)
1.2 mg
6 mg
150 µg
750 µg
13 µg
65 µg
7 µg
35 µg
Manganese (Mn)
0.2 mg
1 mg
Molybdenum (Mo)
10 µg
50 µg
7 µg
35 µg
n
Protein source from soy for patients with milk protein intolerance
Copper (Cu)
n
Lactose free
Iodine (I)
n
n
n
Gluten and cholesterol free, strictly low in purine
Chromium (Cr)
Selenium (Se)
38
per
500 ml
Sodium (Na)
Chloride (Cl)
Lactose free
per
100 ml
per
100 ml
15 %
31 %
54 %
0%
per
500 ml
Nutricomp® Soy
Product Description
Nutricomp® Soy is a normocaloric, nutritionally complete dietary food, with soy
protein, enriched with fish oil, for special medical purposes. It can be used for sip
or tube feeding.
39
Enteral Nutrition
n
n
n
n
n
High biologic value protein from soy protein only
Balanced fatty-acid profile from the combination of rape seed oil,
soy oil and fish oil
Carbohydrate composition from maltodextrin
Fiber sources from inulin, soy, resistant starch and wheat
n Milk protein intolerance
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
103 kcal / 431 kJ
515 kcal / 2155 kJ
Vitamin A
90 µg
450 µg
Protein
3.9 g
19.5 g
Vitamin D
1 µg
5 µg
Fat
3.5 g
17.5 g
Vitamin E
1.5 mg
7.5 mg
13.3 g
66.5 g
Vitamin K
7 µg
35 µg
Fiber
1.5 g
7.5 g
Vitamin B1
0.2 mg
1 mg
Water
83 ml
415 ml
Vitamin B2
0.2 mg
1 mg
Vitamin B6
0.2 mg
1 mg
Vitamin B12
0.3 µg
1.5 µg
Vitamin C
10 mg
50 mg
1.8 mg
9 mg
30 μg
150 μg
0.6 mg
3 mg
5 μg
25 μg
Carbohydrates
Universal Adapter
n
Normocaloric
(1.0 kcal)
Minerals
80 mg
400 mg
Potassium (K)
133 mg
665 mg
Calcium (Ca)
67 mg
336 mg
Niacin
Magnesium (Mg)
24 mg
120 mg
Folic acid
Phosphorus (P)
50 mg
250 mg
Pantothenic acid
100 mg
500 mg
Biotin
Rich in fish oil
Trace Elements
Lactose free
40
Special features
n
Protein source from soy for patients with milk protein intolerance
n
Lactose free
n
n
n
n
Gluten and cholesterol free, strictly low in purine
per
500 ml
Sodium (Na)
Chloride (Cl)
Rich in fiber
per
100 ml
per
100 ml
per
100 ml
per
500 ml
Iron (Fe)
1.2 mg
6 mg
Zinc (Zn)
1.2 mg
6 mg
Copper (Cu)
150 µg
750 µg
13 µg
65 µg
7 µg
35 µg
Manganese (Mn)
0.2 mg
1 mg
Molybdenum (Mo)
10 µg
50 µg
7 µg
35 µg
Iodine (I)
Chromium (Cr)
Selenium (Se)
16 %
30 %
52 %
2%
per
500 ml
41
Nutricomp® Soy Fibre
Product Description
Nutricomp® Soy Fibre is a normocaloric, nutritionally complete dietary food, with
soy protein, enriched with fish oil, for special medical purposes. It can be used for
sip or tube feeding.
Enteral Nutrition
Nutricomp® MCT
Product Description
Nutricomp® MCT is a high-caloric, nutritionally complete dietary food, enriched with
MCT, for special medical purposes. It can be used for sip or tube feeding.
n
n
n
n
n Impaired lipid digestion
n Fat malabsorption
n Steatorrhea
n High energy needs
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
130 kcal / 550 kJ
650 kcal / 2750 kJ
Vitamin A
117 µg
585 µg
Protein
5.6 g
28 g
Vitamin D
1.3 µg
6.5 µg
Fat
4.4 g
22 g
Vitamin E
2 mg
10 mg
Carbohydrates
17 g
85.5 g
Vitamin K
9.1 µg
45.5 µg
Fiber
< 0.1 g
< 0.1 g
Vitamin B1
0.26 mg
1.3 mg
Water
79 ml
395 ml
Vitamin B2
0.26 mg
1.3 mg
Vitamin B6
0.26 mg
1.3 mg
Vitamin B12
0.39 µg
1.95 µg
Vitamin C
13 mg
65 mg
2.3 mg
11.5 mg
39 μg
195 μg
0.78 mg
3.9 mg
6.5 μg
32.5 μg
Universal Adapter
n
1.3
High-caloric
(1.3 kcal)
Minerals
130 mg
650 mg
Potassium (K)
235 mg
1175 mg
Calcium (Ca)
98 mg
490 mg
Niacin
Magnesium (Mg)
26 mg
130 mg
Folic acid
Phosphorus (P)
85 mg
425 mg
Pantothenic acid
130 mg
650 mg
Biotin
Rich in MCT
Trace Elements
Special features
42
per
500 ml
Sodium (Na)
Chloride (Cl)
MCT
per
100 ml
per
100 ml
per
100 ml
per
500 ml
Iron (Fe)
1.6 mg
8 mg
Zinc (Zn)
1.6 mg
8 mg
Copper (Cu)
195 µg
975 µg
Iodine (I)
17 µg
85 µg
Chromium (Cr)
9.1 µg
45.5 µg
0.26 mg
1.3 mg
n
n
Manganese (Mn)
n
Molybdenum (Mo)
13 µg
65 µg
n
Selenium (Se)
9.1 µg
45.5 µg
17 %
30 %
53 %
0%
per
500 ml
43
Enteral Nutrition
n
n
n
n
n
High biologic value protein from different protein sources such as casein and
wheat protein hydrolysate
Balanced fatty-acid profile from the combination of MCT, rape seed oil, sunflower
oil and fish oil
Fiber composition from fructo-oligosaccharides (FOS), soy and wheat dextrin
n Impaired immune functions
n Metabolic stress
n Consuming and Inflammatory diseases
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
136 kcal / 572 kJ
680 kcal / 2860 kJ
Vitamin A
120 µg
600 µg
Protein
6.7 g
33.5 g
Vitamin D
1.3 µg
6.5 µg
Fat
3.7 g
18.5 g
Vitamin E
2 mg
10 mg
18.3 g
91.5 g
Vitamin K
9.3 µg
46.5 µg
Fiber
1.4 g
7g
Vitamin B1
0.27 mg
1.35 mg
Water
78 ml
390 ml
Vitamin B2
0.27 mg
1.35 mg
Vitamin B6
0.27 mg
1.35 mg
Vitamin B12
0.4 µg
2 µg
Vitamin C
13 mg
65 mg
2.4 mg
12 mg
40 μg
200 μg
Carbohydrates
Minerals
per
100 ml
per
500 ml
Universal Adapter
1.3
High-caloric
(1.3 kcal)
129 mg
645 mg
Potassium (K)
200 mg
1000 mg
Calcium (Ca)
98 mg
490 mg
Niacin
Magnesium (Mg)
27 mg
135 mg
Folic acid
Phosphorus (P)
87 mg
435 mg
Pantothenic acid
0.8 mg
4 mg
133 mg
665 mg
Biotin
6.7 μg
33.5 μg
Chloride (Cl)
Rich in fish oil
Trace Elements
Rich in fiber
Glu
44
Rich in glutamine
per
100 ml
per
500 ml
Iron (Fe)
1.6 mg
8 mg
Zinc (Zn)
1.6 mg
8 mg
200 µg
1000 µg
n
n
Copper (Cu)
Rich in glutamine (2 g / 100 ml = 30 g / day) as fuel for rapidly
dividing cells of the gastrointestinal tract and the immune system
Iodine (I)
17 µg
85 µg
Chromium (Cr)
9.3 µg
46.5 µg
0.27 mg
1.35 mg
n
per
500 ml
Sodium (Na)
Special features
per
100 ml
n
Rich in antioxidants
n
n
Molybdenum (Mo)
13 µg
65 µg
n
Cholesterol free, strictly low in lactose and purine
Selenium (Se)
9.3 µg
46.5 µg
Manganese (Mn)
20 %
24 %
54 %
2%
Nutricomp® Immun
Product Description
Nutricomp® Immun is a high-caloric, nutritionally complete dietary food, enriched
with glutamine and fish oil, for special medical purposes. It can be used for sip or
tube feeding and comes in a neutral flavor.
45
Enteral Nutrition
n
n
n
n
High biologic value protein from different protein sources such as branched chain
amino acids, casein, whey and cocoa
n Impaired liver function
n Liver disease
Nutrition information (chocolate flavor)
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
132 kcal / 556 kJ
660 kcal / 2780 kJ
Vitamin A
117 µg
585 µg
Protein
4g
20 g
Vitamin D
1.3 µg
6.5 µg
5.8 g
29 g
Vitamin E
2 mg
10 mg
Carbohydrates
15.5 g
77.5 g
Vitamin K
9.1 µg
45.5 µg
Fiber
0.56 g
2.8 g
Vitamin B1
0.26 mg
1.3 mg
Water
80 ml
400 ml
Vitamin B2
0.26 mg
1.3 mg
Vitamin B6
0.26 mg
1.3 mg
Vitamin B12
0.39 µg
1.95 µg
Vitamin C
13 mg
65 mg
2.3 mg
11.5 mg
39 μg
195 μg
0.78 mg
3.9 mg
6.5 μg
32.5 μg
Fat
Universal Adapter
n
1.3
BCAA
High-caloric
(1.3 kcal)
Minerals
91 mg
455 mg
Potassium (K)
156 mg
780 mg
Calcium (Ca)
72 mg
360 mg
Niacin
Magnesium (Mg)
26 mg
130 mg
Folic acid
Phosphorus (P)
60 mg
300 mg
Pantothenic acid
Chloride (Cl)
91 mg
455 mg
Biotin
Rich in BCAA
Rich in MCT
Special features
46
n
Specific amino acid pattern: 40 % BCAA’s to stimulate protein metabolism
n
n
n
Gluten and cholesterol free, strictly low in lactose
per
500 ml
Sodium (Na)
Trace Elements
MCT
per
100 ml
per
100 ml
per
100 ml
per
500 ml
Iron (Fe)
1.6 mg
8 mg
Zinc (Zn)
1.6 mg
8 mg
Copper (Cu)
195 µg
975 µg
Iodine (I)
17 µg
85 µg
Chromium (Cr)
9.1 µg
45.5 µg
0.26 mg
1.3 mg
Molybdenum (Mo)
13 µg
65 µg
Selenium (Se)
9.1 µg
45.5 µg
Manganese (Mn)
12 %
40 %
47 %
1%
per
500 ml
Nutricomp® Hepa
Product Description
Nutricomp® Hepa is a high-caloric, nutritionally complete dietary food, enriched with
BCAA (Branched chain amino acids), for special medical purposes. It can be used for sip
or tube feeding and comes with a chocolate flavor.
47
Enteral Nutrition
n
n
n
n
Balanced fatty-acid profile from the combination of MCT and soy oils
n Posttraumatic metabolic condition
n Respiratory failure
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
130 kcal / 550 kJ
650 kcal / 2750 kJ
Vitamin A
117 µg
585 µg
Protein
6.5 g
32.5 g
Vitamin D
1.3 µg
6.5 µg
Fat
5.8 g
29 g
Vitamin E
2 mg
10 mg
Carbohydrates
13 g
65 g
Vitamin K
9.1 µg
45.5 µg
Fiber
< 0.1 g
< 0.1 g
Vitamin B1
0.26 mg
1.3 mg
Water
79 ml
395 ml
Vitamin B2
0.26 mg
1.3 mg
Vitamin B6
0.26 mg
1.3 mg
Vitamin B12
0.39 µg
1.95 µg
Vitamin C
13 mg
65 mg
2.3 mg
11.5 mg
39 μg
195 μg
0.78 mg
3.9 mg
6.5 μg
32.5 μg
Universal Adapter
n
1.3
High-caloric
(1.3 kcal)
Minerals
130 mg
650 mg
Potassium (K)
195 mg
975 mg
Calcium (Ca)
98 mg
490 mg
Niacin
Magnesium (Mg)
26 mg
130 mg
Folic acid
Phosphorus (P)
85 mg
425 mg
Pantothenic acid
130 mg
650 mg
Biotin
Rich in MCT
Trace Elements
Low in
carbohydrates
Special features
48
n
Low in carbohydrates (89 % polysaccharides)
n
51 % of MCT (3 g / 100 ml) to facilitate absorption
n
n
per
500 ml
Sodium (Na)
Chloride (Cl)
MCT
per
100 ml
per
100 ml
per
100 ml
per
500 ml
Iron (Fe)
1.6 mg
8 mg
Zinc (Zn)
1.6 mg
8 mg
Copper (Cu)
195 µg
975 µg
Iodine (I)
17 µg
85 µg
Chromium (Cr)
9.1 µg
45.5 µg
0.26 mg
1.3 mg
Molybdenum (Mo)
13 µg
65 µg
Selenium (Se)
9.1 µg
45.5 µg
Manganese (Mn)
per
500 ml
20 %
40 %
40 %
0%
Nutricomp® Intensiv
Product Description
Nutricomp® Intensiv is a high-caloric, nutritionally complete dietary food, low in
carbohydrates and enriched with MCT, for special medical purposes. It can be used
for sip or tube feeding.
49
Enteral Nutrition
Nutricomp® Drink
Nutricomp® Drink is an oral nutritional supplement (ONS) or sip feed, which is nutritionally complete and may be used as supplemental or as a sole source of nutrition.
Recommended Daily Dosage
The recommended daily dose of Nutricomp® Drink depends on the patient requirements and should be tailored to the patient's specific nutritional needs.
For complete nutrition: 6-7 bottles per day
For supplemental nutrition: 1-3 bottles per day
Product Description
Nutricomp® Drink Plus is a high-caloric, nutritionally complete dietary food, enriched
with fish oil, for special medical purposes. Normally it is used for sip feeding and
comes in banana, chocolate, strawberry and vanilla flavors.
n
n
n
n
High biologic value protein such as casein, soy and whey
Balanced fatty-acid profile from the combination of rape seed oil, sunflower oil,
MCT and fish oil
Carbohydrate composition from maltodextrin and saccharose
1.5
High-caloric
(1.5 kcal)
n High energy needs
n Fiber contraindicated
Nutrition information (vanilla flavor)
Key
characteristics
per
100 ml
per
500 ml
Vitamins
Energy
150 kcal / 630 kJ
750 kcal / 3150 kJ
Vitamin A
147 µg
735 µg
Protein
6g
30 g
Vitamin D
1.8 µg
9 µg
Fat
5g
25 g
Vitamin E
2 mg
10 mg
20 g
100 g
Vitamin K
12 µg
60 µg
Fiber
< 0.1 g
< 0.5 g
Vitamin B1
0.18 mg
0.9 mg
Water
76 ml
380 ml
Vitamin B2
0.22 mg
1.1 mg
Vitamin B6
0.22 mg
1.1 mg
Vitamin B12
0.55 µg
2.75 µg
Vitamin C
15 mg
75 mg
2.4 mg
12 mg
45 μg
225 μg
1.1 mg
5.5 mg
8 μg
40 μg
Carbohydrates
Minerals
per
500 ml
Sodium (Na)
100 mg
500 mg
Potassium (K)
170 mg
850 mg
Calcium (Ca)
72 mg
360 mg
Niacin
Magnesium (Mg)
27 mg
135 mg
Folic acid
Phosphorus (P)
60 mg
300 mg
Pantothenic acid
115 mg
575 mg
Biotin
Reclosable cap
Chloride (Cl)
Waisted shape
for handy grip
Contains fish oil
Unbreakable
Special features
n
n
n
Gluten and cholesterol free, strictly low in lactose and purine*
* Nutricomp® Drink Plus chocolate contains 58.5 g / 100 ml purine
50
per
100 ml
per
100 ml
Trace Elements
per
100 ml
per
500 ml
Iron (Fe)
1.7 mg
8.5 mg
Zinc (Zn)
1.2 mg
6 mg
Copper (Cu)
170 µg
850 µg
Iodine (I)
25 µg
125 µg
Chromium (Cr)
16 µg
80 µg
0.58 mg
2.9 mg
Molybdenum (Mo)
12 µg
60 µg
Selenium (Se)
8.3 µg
41.5 µg
Manganese (Mn)
16 %
30 %
54 %
0%
per
500 ml
51
Enteral Nutrition
Medical Devices ...
... with Enteral Nutrition Safety System
New Safety for Medical Devices
One Easy System to Increase Patient Safety
As a leader in safe infusion therapy, B. Braun is dedicated to making the administration of Enteral and Parenteral Nutrition safer.
Reported cases of enteral misconnections have resulted in severe
and fatal consequences for patients.
Whether you are using...
Gravity Systems
B. Braun‘s ambulatory EN pump for administration
or B. Braun‘s universal pump for administration
(B. Braun Space).
Syringes
Connection to diet container
With our new Safety System range of products, we provide you
with all the necessary administration sets, dedicated syringes,
and tubes that will cover all major applications.
One system for all major application
ways and diet containers
n
Glass or Wideneck Bottles
Compounded Diets.
Gravity
application
set
ENPlus Port
in bags
ENPlus Port
in Universal
Adapter
ENPlus Port
in empty bags
identification
n
Works with all diet containers including...
Bags
Dedicated enteral connectors eliminate
the possibility of mixing up Parenteral
with Enteral access ports
n
(Enteroport® plus)
B. Braun understands your requirements for safe administration
of clinical nutrition. Our new Safety System eliminates confusion
between Enteral and Parenteral routes.
52
User benefits
ENPlus Spike
Ambulatory
EN pump
(Enteroport®
plus)
Inverse Safety Y-Port
with matching
Omnifix® Enteral
male
ENLock
female
ENLock
Connection to patient
B. Braun is your partner in providing clinical nutrition by offering
a full line of products for Enteral and Parenteral applications.
Our combined nutritional support allows you to meet the fundamental needs of your patients and positively influence their
clinical outcomes.
Safe & Simple
Universal
pump
(B. Braun
Space)
53
Enteral Nutrition
Nutrifix®
Gravity Administration Sets
ENPlus for Bags
n Incompatible with standard IV drug containers and IV sets
n Easy to Use “Lock and Key” Concept
ENPlus for Universal Adapter
n Incompatible with standard IV drug containers and IV sets
n Easy to Use “Lock and Key” Concept
n Adapter for crown-cork and wideneck bottles
Omnifix® Enteral & Inverse Safety Y-Port
For administration of Enteral Nutrition or enteral drugs and flushing
n Only compatible with enteral syringes
STANDARD Nutrifix® administration sets
Product & Article number
Nutrifix® 1000
Art. no. 9240677
Nutrifix® 2500
Art. no. 9240685
Characteristics
Administration set with 1000 or 2500 ml
storage bag
nEasy to fill
nGraduated scale and label for patient data
nRoller clamp and drip chamber
nInverse Safety Y-Port for Omnifix® Enteral
nStep Adapter
n
n
Nutrifix® FL
Art. no. 9240669
ENLock (male & female)
Incompatible with IV connections
n Compatible with most funnel tubes and step connectors
n
Nutrifix® Multispike
Art. no. 9240632
SAFETY Nutrifix® administration sets
Nutrifix®
1000 ml Safety
Art. no. 9240678
Nutrifix®
Universal Adapter Safety
Art. no. 9240622
54
Characteristics
Administration set with 1000 ml storage bag
Easy to fill
nStep Adapter
n
n
Administration set with Universal Adapter
ENPlus Port in Universal Adapter
nWith ENPlus Spike
nStep Adapter
nConnection to bag systems, crown-cork
and wideneck bottles, syringes and empty bags
n
n
Nutrifix® Universal Adapter
Art. no. 9240621
Administration set with bottle connector
for crown-cork bottles
nStep Adapter
n
Administration set with Multispike
Roller clamp and drip chamber
nStep Adapter
nConnection to all bag systems
n
n
nStep Adapter
nConnection to all bag systems, crown-cork
n
n
All administration sets are DEHP-free. The step adapter is connectable to tubes with Luer, Luer-Lock, Funnel connector and female
ENLock connector.
55
Enteral Nutrition
Enteroport® plus
Enteral Nutrition Pump and compatible Administration Sets
Enteroport® plus 230 V
(includes power supply and pole clamp)
Art. no. 8710355
Accessories:
Pole clamp; Art. no. 8721061
Staff Call; Art. no. 8721548
Support Stand; Art. no. 8721670
SAFETY Enteroport® administration sets
Enteroport® plus Set
1000 ml Safety
Art. no. 9240678
Universal Adapter Safety
Art. no. 8721745
56
The Enteroport® Plus is an Enteral Nutrition pump
for controlled gastric and intestinal application of
tube feeding diets that is suitable for outpatient use.
Properties
Mobile pump
nApplication rate: 1 - 400 ml/h
nFlow rate accuracy +/- 10 %
nProgramming information via illuminated
LCD display
nIntegrated safety and control functions
with acoustic and visual alarms
nOperating modes
nMemory function
nSafe function
nRechargeable batteries and mains input
nAccessories like staff call, support-stand
and pole clamp
n
Characteristics
Easy to fill
nStep Adapter
STANDARD Enteroport® administration sets
Enteroport® plus Set 500
Art. no. 8721726
Art. no. 8721734
Art. no. 8721742
FL
Art. no. 8721688
Multispike
Art. no. 8721750
n
n
nWith ENPlus Spike
nStep Adapter
n
n
Universal Adapter
Art. no. 8721744
Characteristics
Administration set with 500, 1000 or
2500 ml storage bag
nEasy to fill
nStep Adapter
n
Administration set with bottle connector
for crown-cork bottles
nStep Adapter
n
Administration set with Multispike
nStep Adapter
nConnection to all bag systems
n
n
nStep Adapter
n
n
ENLock connector.
57
Enteral Nutrition
Infusomat® Space System
Universal Pump System and compatible Administration Sets
Infusomat® Space Pump
Art. no. 8713050
Accessories:
Pole clamp; Art. no. 8712120
Support Stand; Art. no. 8713135
The Infusomat® Space is a volumetric infusion pump
of the new generation and one of the basic building
blocks of the Space system. For inpatient use.
STANDARD Infusomat® Space
administration sets
Infusomat® Space Line
Type Enteral Nutrition with
1000 ml nutrition bag
Art. no. 8250839SP
Properties
Small, light, handy pumps
Clearly structured display, excellent readability
nCell phone like intuitive operation
nAutomatic free-flow protection when removing
lines
n
n
Type Enteral Nutrition with
universal connector
Art. no. 8250857SP
There are two types of Infusomat® Space Lines
which are specially designed for Enteral Nutrition.
SAFETY Infusomat® Space administration sets
1000 ml
Art. no. 8250836SP
Universal Adapter
Art. no. 8250856SP
58
Characteristics
nEasy to fill
nStep Adapter
nDEHP-free
n
nWith ENPlus Spike
nStep Adapter
nPVC-free
n
n
Characteristics
Easy to fill
nStep Adapter
n
n
nStep Adapter
n
n
ENLock connector.
SAFETY Perfusor® Space administration sets
Perfusor® Line Safety
Art. no. 8722930
Characteristics
Administration set for exact bolus application
(in connection with Perfusor® pump)
nPatient side is connectable with step adapter or
male ENLock adapter
nContainer side is connectable with Omnifix®
Enteral
nInner diameter 1,0 mm
nLength 150 cm
nStep Adapter
nPVC-free
n
59
Enteral Nutrition
Fluid and bolus application
Empty Bags, Syringes and Accessories
SAFETY
60
Characteristics
Omnifix® Enteral
5 ml – Art. no. 4616005-01
10 ml – Art. no. 4616010-01
20 ml – Art. no. 4616020-01
50/60 ml – Art. no. 4616050-01
n
Omnifix® Enteral Straw
10 cm – Art. no. 4616006
17 cm – Art. no. 4616007
n
Omnifix® Enteral
Combi stopper
Art. no. 4495102
n
STANDARD
Safety Inverse Luer-Lock System
nOnly connectable to Inverse Safety Y-Port
nGraduations of 0.2, 0.5 and 1.0 ml
Enterofix® 1000
Art. no. 9240799
Suitable for Omnifix® Enteral
nEasy withdrawal of oral medications and
Enteral Nutrition
Exadoral®
1 ml – Art. no. 4608661
2 ml – Art. no. 4608662
5 ml – Art. no. 4608660
10 ml – Art. no. 4608667
20 ml – Art. no. 4608663
Suitable for Omnifix® Enteral
For easier storage and transportation of syringe
Characteristics
1000 ml storage/empty bag for fluid application
To be used in connection with all application
sets with a Multispike
nEasy to fill
nDEHP-free
n
n
Application of oral liquid drugs
Safe non-luer tip design
nExact withdrawal and dosing
nGraduations of 0.1, 0.2, 0.5, 1.0 ml
n
n
n
Purple sticker for faster identification
Exadoral® straw
10 cm – Art. no. 4608670
17 cm – Art. no. 4608671
Purple sticker for faster identification
Exadoral® bottle adapter
24 mm – Art. no. 4608672
28 mm – Art. no. 4608673
Enteral Sticker for
Infusomat® Space
10 Pcs. – Art. no. 34770986
n
Enteral Sticker for
Perfusor® Space
10 Pcs. – Art. no. 34770990
n
Exadoral® syringe cap
(Add-ProTM syringe cap)
Art. no. 418200
n
n
Excact administration without spilling
Prohibits wasting drugs
Easy withdrawal of drugs from the bottle
to the oral dispenser
n Without leaking
n
n
n
Seals the syringe completely
Avoids leaking and wasting drugs
61
Enteral Nutrition
Enteral Nutrition Feeding Tubes
Safer Connection to the Patient
Access to the Body – Different Possibilities
The new ENLock System
Safer & Simple
There are different ways to access the body via
an Enteral Nutrition feeding tube:
Nasal Tubes
n Nasogastric tubes
A nasogastric feeding tube is passed through the nostril,
down the esophagus and into the stomach. This type of feeding
tube is generally used for short term feeding.
n Nasoenteral tubes (nasoduodenal tubes + nasojejunal tubes)
A nasoenteral feeding tube is passed through the nostril,
down the esophagus and into the duodenum or jejunum.
User benefits
Percutaneous Tubes
n Percutaneous Endoscopic Gastrostomy (PEG)
The tube goes through the skin of the abdomen directly
into the stomach.
n Jejunostomy
The tube goes through the skin of the abdomen directly
into the jejunum.
Dedicated enteral connectors eliminate
the possibility of mixing up Parenteral
with Enteral access ports
PVC tubes
for short-term nasogastric or nasoenteral feeding.
n
PUR tubes
for long-term nasogastric or nasoenteral feeding.
identification
n
One system for all major application
ways and diet containers
n
When to choose which type of tube
Oral Nutrition
No longer possible / No longer adequate
No surgery
Short-term or
unknown duration



No risk of
aspiration
and reflux
No stomach
problems
Nasogastral
tube



Long-term duration
Nasal tubes impossible
(e.g. blockage in the esophagus)
Risk of
aspiration
and reflux
Stomach
problems
No surgery


Nasoenteral
tube
No risk of
aspiration
No stomach
problems

PEG
Surgery
Risk of
aspiration
and reflux
Stomach
problems




PEJ
JET-PEG

NCJ
Prolonged requirement
62
63
Enteral Nutrition
Nasal and Percutaneous Tubes
Safer Connection to the Patient
Access to the Body – Different Possibilities
Nutritub® – Polyurethane feeding tubes
Connector
French /
Charriere
Length
Pediatric tube
Nutritub® Paed
Art. no. 9246509
LL
CH 6
60 cm
Characteristics
For long term naso-gastric and
naso-intestinal tube feeding.
n
Naso-gastric tubes
Nutritub® Gastral
Art. no. 9246517
LL
Nutritub® Gastral
Art. no. 9246525
LL / M
Nutritub® Gastral
Art. no. 9246533
TR / M
n
CH 8
CH 8
100 cm
100 cm
n
CH 8
100 cm
n
Nutritub® Gastral
Art. no. 9246541
TR / M
Nutritub® Gastral T
Art. no. 9246550
TR
CH 12
100 cm
n
CH 15
100 cm
n
Naso-intestinal tubes
Nutritub® Intestinal
Art. no. 9246576
TR / M
Nutritub® Intestinal
Art. no. 9246584
TR / M
CH 8
CH 12
Made of soft polyurethane,
flexible, without DEHP
Radiopaque (stripes), length
markings every 10 cm allowing
an easy and safe placement
control
Male Luer Lock (LL) connector/
funnel connector (FR) with
integrated syringe adapter
Connectors allow connection
with any application system
Some tubes are equipped with
stylet (Mandrin M)
Nutritub® Intestinal have
weighted ends to ensure
intestinal placement
120 cm
Gastric tubes – Nasogastric PVC tubes
French /
Charriere
Length
2 lateral eyes • Luer connector with closure cap
L
Gastric tube
Art. no. 4396057
L
Gastric tube
Art. no. 4396154
L
CH 6
50 cm
Gastric tube
Art. no. 4396251
L
CH 9
50 cm
Gastric tube
Art. no. 4396308
L
CH 9
100 cm
Gastric tube
Art. no. 4396359
L
CH 12
50 cm
Gastric tube
Art. no. 4396405
L
CH 12
100 cm
CH 4.5
Characteristics
For short term use only.
Gastric tube
Art. no. 4396049
38 cm
n
n
CH 4.5
50 cm
n
Radiopaque (stripe)
Luer (L) & funnel (TR)
connector
Gastric tube CH16 equipped
with stylet (Mandrin M)
4 lateral eyes and mandrin (stylet) • funnel connector
Gastric tube
Art. no. 4372166
120 cm
Connector
TR / M
CH 16
80 cm
L: Luer, TR: funnel connector, TR / M: funnel connector / Mandrin (stylet)
LL: Luer-Lock, TR: funnel connector, LL / M: Luer-Lock / Mandrin (stylet), TR / M: funnel connector / Mandrin (stylet)
Duodenal tubes (Levin)
Duodenal tube
Art. no. 4371143
Connector
French/
Charriere
Length
TR
CH 14
122 cm
Characteristics
n
n
n
Duodenal tube
Art. no. 4371160
TR
Duodenal tube
Art. no. 4371186
TR
CH 16
122 cm
n
CH 18
122 cm
Latex free, without DEHP
Single and sterile packaging
For aspiration of intestinal fluid
or for administration of Enteral
Nutrition
Funnel connector with 4 lateral
eyes, radiopaque stripes and
rounded end
TR: funnel connector
64
65
Clinical Nutrition
Product Description Parenteral Nutrition
Composition
Each 1000 ml contains:
Amino acids: (g)
Isoleucine
Leucine
Lysine acetate
(equivalent to Lysine)
Lysine monohydrate
(equivalent to Lysine)
Methionine
Phenylalanine
Threonine
Tryptophan
Valine
Arginine
Histidine
Alanine
Glycine
Aspartic acid
Glutamic acid
Proline
Serine
Tyrosine
5%E10%10 %E
2.50
4.45
2.87
2.03
1.56
3.42
2.20
2.35
2.10
0.80
3.10
5.75
1.50
5.25
6.00
2.80
3.60
2.75
1.15
0.40
5.00
8.90
5.74
4.07
3.12
2.78
4.40
4.70
4.20
1.60
6.20
11.50
3.00
10.50
12.00
5.60
7.20
5.50
2.30
0.40
5.00
8.90
5.74
4.07
3.12
2.78
4.40
4.70
4.20
1.60
6.20
11.50
3.00
10.50
12.00
5.60
7.20
5.50
2.30
0.40
Aminoplasmal®-15% /15%E
Composition
Active ingredients (g)
Isoleucine
Leucine
Lysine Monohydrate
(equivalent to Lysine 7.95 g)
Methionine
Phenylalanine
Threonine
Tryptophan
Valine
Arginine
Histidine
Glycine
Alanine
Proline
Aspartic Acid
Acetylcysteine
(equivalent to Cysteine 0.37 g)
Glutamic Acid
Serine
Tyrosine
5.85
11.40
8.93
5.85
11.40
8.93
5.70
5.70
5.40
2.10
7.20
16.05
5.25
19.20
22.35
7.35
7.95
0.50
5.70
5.70
5.40
2.10
7.20
16.05
5.25
19.20
22.35
7.35
7.95
0.50
16.20
3.00
0.50
16.20
3.00
0.50
150g
150g
24.0g
24.0g
600
600
1290
1480
30 mmol 30 mmol
5.5 – 7.0 5.5 – 7.0
Aminoplasmal® Hepa 10%
Composition
Isoleucine
Leucine
Lysine Acetate
(equivalent to Lysine 7.51 g)
Methionine
Phenylalanine
Threonine
Tryptophan
Valine
Arginine
Histidine
Glycine
Alanine
Proline
Aspartic Acid
Asparagine · H2O
(equivalent to Asparagine 0.48 g)
8.80 g
13.60 g
10.60 g
1.20 g
1.60 g
4.60 g
1.50 g
10.60 g
8.80 g
4.70 g
6.30 g
8.30 g
7.10 g
2.50 g
0.55 g
Acetylcysteine
0.80 g
(equivalent to Cysteine 0.59 g)
Glutamic Acid
5.70 g
Ornithine Hydrochloride
1.66 g
(equivalent to Ornithine 1.35 g)
Serine
3.70 g
Acetyltyrosine
0.86 g
(equivalent to Tyrosine 0.67 g)
Water for Injections
to 1000 ml
Total amino acids
100 g/l
Total nitrogen
15.3 g/l
Caloric value:
1675 kJ/l 400 kcal/l
Osmolarity:
875 mOsm/l
Electrolytes:
Acetate
51 mmol/l
Chloride
10 mmol/l
Specific Product Information may differ from country to country
66
5 %E10%10 %E
50
100
100
8
16
16
200
400
400
588
864
1,021
5.7 – 6.3 5.7 – 6.3 5.7 – 6.3
Electrolytes (mmol)
Sodium 50
-
50
Potassium 25
-
25
Magnesium
2.5 -2.5
Phosphate 10
-
10
Acetate
35 -46
Chloride
45 -52
Therapeutic indications: Supply of substrate for protein synthesis in Parenteral Nutrition.
Contraindication: Severe circulation disorders with vital threat (i.e. shock); Cellular oxygen deficiency
(hypoxia) or acidosis; On account of its amino acid composition, is not to be administered in infants and
children up to the completed 2nd year.
Special warnings and special precautions for use: Aminoplasmal® B. Braun 10% should only be administered after careful benefit-risk assessment in the presence of: disorders of amino acid metabolism, hyperhydration, hypokalaemia, hyponatraemia.
Glucose Intravenous Infusion
Composition
Each 1000 ml solution contains:
Glucose
10%20 %30 %40 %50 %70%
Glucose
(g) 100200300400500700
As glucose monohydrate
(g) 110 220330440550770
Carbohydrate contents
(g) 100200300400500700
Caloric value
(kJ/
1675/3350/5025/6700/8375/11725/
kcal) 400 800 1200160020002800
Theor. Osmolarity
(mOsm/l)
555 1100 1665222027703880
Electrolytes (mmol)
Sodium -
50
Potassium -
30
Magnesium
-2,6
Phosphate -
9,0
Acetate
-35
Chloride
-36
Indications: Supply of substrate for protein synthesis in the setting of Parenteral Nutrition.
In Parenteral Nutrition, amino acid infusions should always be accompanied by administration of sufficient
amounts of caloric solutions, e.g. carbohydrate solutions.
Contraindications
Aminoplasmal® – 15% must not be used when there are
- Disorders of amino acid metabolism;
- Acute renal failure with increased non-protein nitrogen concentrations in the serum;
- Advanced liver disease;
- Acidosis;
- Hyperhydration;
- Hyponatraemia;
- Hypokalaemia;
- Dangerous circulation disorders (shock);
This solution should not be given to neonates, infants, and children up to the completed 2nd year as the
nutrient relations do not properly meet the special paediatric requirements.
Precautions for use and special warnings:
- Individual dosage regimens must be established for patients with hepatic and renal insufficiency.
- Caution is to be exercised in patients with increased serum osmolarity.
- Clinical supervision should include regular checks of fluid balance, serum electrolytes, blood glucose and
acid-base balance.
Contraindications:
- Elevated blood sugar concentration (hyperglycaemia)
- Decreased blood potassium concentration (hypokalaemia)
- High concentration of acid substances in blood (acidosis)
- Hyperhydration
- Simultaneous sodium and water deficiency (hypotonic dehydration)
Special warnings and precautions for use
This solution should only be administered with caution to patients with increased serum osmolarity.
Patient monitoring should include regular checks of the blood glucose level, depending on the
prevailing metabolic condition and the administered dose. Patient monitoring should also include regular
checks of the water balance, the serum electrolyte concentrations – in particular serum potassium – and
the acid-base balance.
Glucose Infusions should not be administered through the same infusion equipment, simultaneously with,
before, or after administration of blood, because of the possibility of pseudo-agglutination.
Indications:
- Energy supply by means of glucose
- Carbohydrate component in Parenteral Nutrition
- Therapy of hypoglycaemia
Subject to sale by pharmacists only.
B. Braun Melsungen AG
34209 Melsungen, Germany
15%15 %E
Aminoplasmal®
15 %15 %E
Excipients
Sodium hydroxide, disodium edetate, water for injections
Total amino acids (g)
Total nitrogen (g)
Caloric value (kcal)
Theoretical osmolarity (mOsmol)
Titration acidity (to pH 7.4)
pH
Total amino acids (g)
Total Nitrogen (g)
Caloric value (kcal)
Theoretical osmolarity (mOsmo/L)
pH Product Description Parenteral Nutrition
Lipofundin® MCT/LCT 1
Composition
1000 ml emulsion contain
Lipofundin® Lipofundin®
MCT/LCT 10% MCT/LCT 20%
Soybean oil
50.0 g
100.0 g
Mediumchain Triglycerides 50.0 g
100.0 g
Glycerol
25.0 g
25.0 g
Egg yolk phospholipids*
8.0 g
12.0 g
Sodium Oleate, a-Tocopherol*, Water for injections
Caloric Value (kcal): 1022 1908
Theor. osmolarity (mOsmo/L)345
380
pH:
6.5-8.86.5-8.5
* The amount of egg yolk phospholipids and
a-tocopherol can vary is some countries. Please
refer to the country representative. Soybean oil is a
refined natural product containing neutral triglycerides of predominantly unsaturated fatty acids.
Medium-chain triglycerides are a mixture of neutral
triglycerides of mainly caprylic (about 60%) and
capric acid (about 40%).
Indications:
Lipofundin® MCT/LCT is indicated as a source of
calories and essential fatty acids for patients requiring Parenteral Nutrition.
Contraindications:
The administration of Lipofundin® MCT/LCT is contraindicated in patients demonstrating disturbances
in normal fat metabolism such as pathologic hyperlipaemia, lipoid nephrosis, or acute pancreatitis if
accompanied by hyperlipaemia. It is further contraindicated in patients with ketoacidosis or hypoxia, in thromboembolism and in acute shock states.
Precautions for use:
Caution should be exercised in administering intravenous fat emulsions in patients with metabolic
acidosis, severe liver damage, pulmonary disease,
sepsis, diseases of the reticuloendothelial system,
anaemia or blood coagulation disorders or when
there is danger of fat embolism. Administration of
Lipofundin® MCT/LCT should be accompanied by
simultaneous carbohydrate infusions making up to
40% (at least) of the total calorie intake.
When Lipofundin® MCT/LCT is administered, the
patient's capacity to eliminate the infused fat from
the circulation must be monitored. The lipaemia
must clear between daily infusions. Especially where
fat emulsions are administered for extended periods
of time, the patient's haemogram, blood coagulation, liver function and platelet count should be
closely monitored.
Paediatric patients: studies have shown the safety
and effectiveness of Lipofundin® MCT/LCT as part of
total Parenteral Nutrition in neonates and older
children.
Lipofundin® MCT/LCT has been aproved for usage in
this patient population in some countries.
Registration procedures are currently pursued in
other countries. As long as approval has not been
obtained in a specific country it is up to the judgement of the responsible physician whether or not to
use Lipofundin® MCT/LCT in this patient group.
Use in pregnancy and lactation
The safety of Lipofundin® MCT/LCT during pregnancy
and lactation has not been assessed, but its use dur-
ing these periods is not considered to constitute a
hazard. Nevertheless, medicines should not be used
in pregnancy, especially during the first trimester,
unless the expected benefit is thought to outweigh
any possible risk to the foetus.
Special warnings:
The too rapid infusion of fat emulsions can cause
fluid and/or fat overloading resulting in dilution of
serum electrolyte concentrations, overhydration,
congested states, pulmonary oedema, impaired pulmonary diffusion capacity. A too rapid infusion of
Lipofundin® MCT/LCT can also cause hyperketonaemia and/or metabolic acidosis, especially when carbohydrates are not administered simultaneously.
Indications:
Treatment of hepatic encephalopathy.
Parenteral Nutrition in liver diseases when hepatic encephalopathy is either imminent or already manifest.
Normalisation of amino acid imbalances arising
from severe liver diseases.
Contraindications:
Disturbances of amino acid metabolism of other
than hepatic origin, acidosis, overhydration,
hypokalaemia.
Precautions:
Clinical supervision should include regular checks of
fluid balance and serum electrolytes. Carbohydrates
and electrolytes are to be supplemented as
required. Caution is to be exercised in patients with
hyponatraemia or with increased serum osmolarity.
Unusally rapid infusion rates may produce signs of
intolerance and renal amino acid losses resulting in
amino acid imbalances.
In cases of concurrent renal insufficiency the dos-
age of amino acids has to be adapted to the
serum urea and creatinine values. Amino acid
therapy is not a substitute for established therapeutic measures, such as purging, administration
of lactulose and/or gut sterilising antibiotics, in
the treatment of hepatic encephalopathy.
It is not recommended that any additives be
incorporated into Aminoplasmal® Hepa-10 %
solution, but should preferably be given in standard carbohydrate or electrolyte solutions. How
ever, if admixture with Aminoplasmal® Hepa10 % is essential, then the compatibility of the
additive must be checked before administration.
Side-effects
Provided contraindications, dosage recommendations and precautions are observed, side-effects
are not anticipated.
Subject to sales by pharmacists only.
67
Clinical Nutrition
Special warnings and precautions for use
Lipoplus®/ Lipidem® 20%
Composition
1000 ml of emulsion contains:
Medium-chain triglycerides:
100.0 g
Soybean oil, refined:
80.0 g
Omega-3-acid triglycerides:
20.0 g
Essential fatty acid content per liter:
Linoleic acid (omega-6):
48.0 - 58.0 g
Alpha-linolenic acid (omega-3):
5.0 - 11.0 g
Eicosa-pentaenoic acid and docosahexaenoic acid:
8.6 - 17.2 g
Caloric content per liter:
7900 kJ ≈ 1910 kcal
Osmolality:
approx. 410 mOsm/kg
Titration acidity or alkalinity (to pH 7.4): less than 0.5 mmol/l NaOH or HCl
pH:
6.5 - 8.5
Indications:
Source of calories and essential omega-6 fatty acids and omega-3 fatty acids as a component of a
Parenteral Nutrition regimen for adults.
Contraindications:
Lipoplus® must not be used in any of the following conditions:
– Severe hyperlipidemia
– Serious blood clotting disorders
–Acidosis
– Intrahepatic cholestasis
– Severe liver failure
– Severe kidney failure
– Acute phase of myocardial infarction or stroke
– Acute thromboembolic disease, fat embolism
– Known hypersensitivity to egg, fish, or soybean protein
The following conditions are general contraindications to Parenteral Nutrition.
– Unstable hemodynamic status with compromised vital functions (conditions of collapse and shock)
– Fluid overload
– Acute pulmonary edema
Before infusing a fat emulsion together with other solutions via a Y connector or bypass set, the compatibility of these fluids should be checked, especially when co-administering carrier solutions to which drugs
have been added. Particular caution should be exercised when co-infusing solutions that contain divalent
electrolytes (such as calcium).
The emulsion should always be brought to room temperature prior to infusion.
If filters are used, these must be permeable to fat emulsions.
Serum triglycerides should be monitored during the infusion of Lipoplus®. In patients with suspected disorders of lipid metabolism, fasting lipemia should be ruled out before the start of the infusion.
Hypertriglyceridemia 12 hours after the administration of fat is also indicative of abnormal lipid metabolism.
Transient hypertriglyceridemia or elevated blood glucose levels may arise from the patient's metabolic
status. If the plasma triglyceride concentration rises to more than 3 mmol/l during administration of the
fat emulsion, it is recommended to reduce the infusion rate. If the plasma triglyceride concentration still
remains higher than 3 mmol/l, the infusion should be stopped until the plasma triglyceride concentration
normalizes.
Electrolytes, water balance or body weight, acid-base balance, blood glucose levels, and, during long-term
administration, blood counts, coagulation status, and liver function should be monitored.
There is as yet no clinical experience of the use of Lipoplus® in children, and there is only limited experience of its use in patients with diabetes mellitus or renal impairment.
There is as yet only limited experience of the use of Lipoplus® for periods longer than seven days.
Caution should be exercised in patients with conditions associated with impaired lipid metabolism, such
as renal insufficiency, uncontrolled diabetes mellitus, pancreatitis, hepatic insufficiency, hypothyroidism (in the presence of hypertriglyceridemia), and sepsis.
Lipids may interfere with certain laboratory tests (such as bilirubin, lactate dehydrogenase, oxygen
saturation) when the blood sample is taken before the lipids have been eliminated from the bloodstream.
In most patients this takes 5 to 6 hours beyond the end of the infusion.
The use of fat emulsions as the sole source of calories may give rise to metabolic acidosis. This may be avoided
by the concurrent infusion of carbohydrates. It is therefore recommended to infuse an adequate quantity of
intravenous carbohydrates or an amino acid solution containing carbohydrates along with the fat emulsion.
Vitamin E can interfere with the effect of vitamin K in clotting factor synthesis. This should be borne in
mind in patients with blood clotting disorders or suspected vitamin K deficiency.
Nutriflex®
Composition
Nutriflex® (mixed and ready for use 1000 ml)
Active ingredients
Nutriflex®
peri basal plusspecial
(40/80)(32/125)(48/150) (70/240)
L-isoleucine
2.34 g
1.88 g
2.82 g
4.11 g
L-leucine
3.13 g
2.50 g
3.76 g
5.48 g
L-lysine HCl
2.84 g
2.27 g
3.41 g
4.97 g
(equivalent to L-lysine)
2.27 g
1.82 g
2.73 g
3.98 g
L-methionine
1.96 g
1.56 g
2.35 g
3.42 g
L-phenylalanine
3.51 g
2.81 g
4.21 g
6.15 g
L-threonine
1.82 g
1.45 g
2.18 g
3.18 g
L-tryptophan
0.57 g
0.46 g
0.68 g
1.00 g
L-valine
2.60 g
2.08 g
3.12 g
4.54 g
Arginine glutamate
4.98 g
3.98 g
5.98 g
8.72 g
(equivalent to Arginine
2.70 g
2.16 g
3.24 g
4.73 g
and to Glutamic acid)
2.28 g
1.82 g
2.74 g
3.99 g
1.69 g
1.35 g
2.03 g
2.96 g
L-histidine · HCl · H2O
(equivalent to Histidine)
1.25 g
1.00 g
1.50 g
2.19 g
L-alanine
4.85 g
3.88 g
5.82 g
8.49 g
L-aspartic acid
1.50 g
1.20 g
1.80 g
2.63 g
L-(+)-glutamic acid
1.22 g
0.98 g
1.47 g
2.15 g
Amino acetic acid
1.65 g
1.32 g
1.98 g
2.89 g
L-proline
3.40 g
2.72 g
4.08 g
5.95 g
L-serine
3.00 g
2.40 g
3.60 g
5.25 g
88.00 g
137.50 g
165.00 g
264.00 g
Glucose · H2O
(equivalent to anhydrous glucose)
80.00 g
125.00 g
150.00 g
240.00 g
Sodium chloride
0.17 g
0.37 g
Calcium chloride · 2H2O
0.86 g
Magnesium acetate · 4H2O
–
Sodium dihydrogen phosphate · 2H2O
Potassium dihydrogen phosphate
0.78 g
1.56 g
Sodium acetate · 3H2O
Potassium hydroxide
0.52 g
Sodium hydroxide
0.50 g
Water for injections to
1000 ml
1.40 g
0.53 g
1.23 g
–
1.74 g
3.20 g
0.96 g
0.10 g
1000 ml
–
0.53 g
1.23 g
3.12 g
–
1.56 g
1.40 g
0.23 g
1000 ml
68
–
0.60 g
1.08 g
–
2.00 g
1.63 g
0.62 g
1.14 g
1000 ml
Nutriflex®
Total amino acids (g/l)
Total nitrogen (g/l)
Total carbohydrates (g/l)
Total energy kJ/l
(kcal/l)
Non-protein energy kJ/l
(kcal/l)
Osmolarity (mOsm/l)
peri basal plusspecial
(40/80)(32/125)(48/150) (70/240)
40
32
48
70
5.7
4.6
6.8
10.0
80
125
150
240
2010
2640
3310
5190
(480)(630)(790)(1240)
1340
2090
2510
4020
(320)(500)(600) (960)
900
1140
1400
2100
Electrolytes:
+
Na K+
Ca++
Mg++
Cl–
H2PO4–
Acetate
mmolmmolmmol mmol
27.049.937.2 40.5
15.030.025.0 25.7
2.53.63.6 4.1
4.05.75.7 5.0
31.650.035.5 49.5
5.712.820.0 14.7
19.535.022.9 22.0
Indication
Parenteral Nutrition.
Contraindications
Nutriflex® is contraindicated in cases of hyperglycaemia, disorders of amino acid metabolism, manifest
congestive cardiac failure, untreated shock, overhydration, enhanced plasma potassium levels, acidosis. In
hepatic or renal insufficiency the dosage is to be individually adjusted. Because of the specific composition of the nutrients the use of Nutriflex® in newborns, infants and children up to the 2nd year of life is
not recommended.
Precautions
Serum ionogram, water balance, blood glucose levels and acid-base balance are to be monitored. Possible
intolerance reactions (nausea, vomiting, chills) and renal loss of glucose and amino acids with subsequent
amino acid imbalances are due to a too rapid infusion rate.
Adverse reactions
Adverse reactions are not to be expected, and besides have not been reported so far, if contraindications,
dosage recommendations, warnings and precautions are observed.
NuTRIflex® Lipid
Abbreviated prescribing information: NuTRIflex® Lipid peri/NuTRIflex® Lipid plus/NuTRIflex® Lipid
special/NuTRIflex® Lipid plus without electrolytes/NuTRIflex® Lipid special without electrolytes:
Emulsion for infusion.
Qualitative and quantitative composition in 1000 ml:
From the upper, left-hand chamber (glucose solution): Glucose monohydrate 70.4 g/132.0 g/158.4 g/
132.0 g/ 158.4 g, equivalent to anhydrous glucose 64.0 g/120.0 g/144.0 g/120.0 g/144.0 g, Sodium dihydrogenphosphat dihydrat 0.936 g/1.870 g/2.496 g/-/-, Zinc acetate dihydrate 5.30 mg/5.26 mg/7.02 mg/-/-,
From the upper, right-hand chamber (fat emulsions): Medium-chain triglycerides 20.0 g/20.0 g/20.0 g/
20.0 g/ 20.0 g, Soya-bean oil, refined 20.0 g/20.0 g/20.0 g/20.0 g/20.0 g,
From the lower chamber (aminoacid solution): Isoleucine 1.87 g/2.26 g/3.28 g/2.26 g/3.28 g, Leucine
2.50 g/3.01 g/4.38 g/3.01 g/4.38 g, Lysine hydrochloride 2.27 g/2.73 g/3.98 g/-/-, Lysine monohydrate
-/-/-/2,45 g/3,58 g, equivalent to Lysine 1.81 g/2.18 g/3.18 g/2.18 g/3.18 g, Methionine 1.57 g/1.88
g/2.74 g/1.88 g/2.74 g, Phenylalanine 2.81 g/3.37 g/4.92 g/3.37 g/4.92 g, Threonine 1.46 g/1.74 g/2.54
g/1.74 g/2.54 g, Tryptophan 0.46 g/ 0.54 g/0.80 g/0.54 g/0.80 g, Valine 2.08 g/2.50 g/3.60 g/2.50 g/3.60 g,
Arginine 2.16 g/2.59 g/3.78 g/2.59 g/ 3.78 g, Histidine hydrochloride monohydrate 1.35 g/1.62 g/2.37 g/-/-,
equivalent to Histidine 1.00 g/1.20 g/1.75 g/ 1.20 g/1.75 g, Alanine 3.88 g/4.66 g/6.79 g/4.66 g/6.79 g,
Aspartic acid 1.20 g/1.44 g/2.10 g/1.44 g/2.10 g, Glutamic acid 2.80 g/3.37 g/4.91 g/3.37 g/4.91 g, Glycine
1.32 g/1.58 g/2.31 g/1.58 g/2.31 g, Proline 2.72 g/3.26 g/4.76 g/3.26 g/4.76 g, Serine 2.40 g/2.88 g/4.20 g/
2.88 g/4.20 g, Sodium hydroxide 0.640 g/ 0.781 g/ 1.171 g/-/-, Sodium chloride 0.865 g/0.402 g/0.378 g/-/-,
Sodium acetate trihydrate 0.435 g/ 0.222 g/0.250 g/-/-, Potassium acetate 2.354 g/2.747 g/3.689 g/-/-,
Magnesium acetate tetrahydrate 0.515 g/0.686 g/0.910 g/-/-, Calcium chloride dihydrate 0.353 g/0.470 g/
0.623 g/-/-,
Electrolytes (mmol): Sodium 40/40/53.6/-/-, Potassium 24/28/37.6/-/-, Magnesium 2.4/3.2/4.2/-/-,
Calcium 2.4/3.2/4.2/-/-, Zinc 0.024/0.024/0.03/-/-, Chloride 38.4/36/48/-/-, Acetate 32/36/48/-/-,
Phosphate 6/12/16/-/-, Amino acid content (g) 32/38/56.0/38/56.0, Nitrogen content (g) 4.6/5.4/8/5.4/8,
Carbohydrate content (g) 64/120/144/120/144, Lipid content (g) 40/40/40/40/40, Energy in the form of
lipid [kJ (kcal)] 1590 (380)/1590 (380)/1590 (380)/1590 (380)/1590 (380), Energy in the form of carbohydrate [kJ (kcal)] 1075 (255)/2010 (480)/2415 (575)/2010 (480)/2415 (575), Energy in the form of amino
acids [kJ (kcal)] 535 (130)/635 (150)/ 940 (225)/635 (150)/940 (225), Non-protein energy [kJ (kcal)] 2665
(635)/3600 (860)/4005 (955)/3600 (860)/ 4005 (955), Total energy [kJ (kcal)] 3200 (765)/4235 (1010)/4945
(1180)/4235 (1010)/4945 (1180), Osmolality (mOsm/kg) 950/1540/2115/1350/1840, Theoretical osmolarity
(mOsm/l) 0/1215/1545/1055/1330, pH 5.0-6.0/5.0-6.0/ 5.0-6.0/5.0-6.0/5.0-6.0.
List of excipients: Citric acid monohydrate (for pH adjustment), egg lecithin, glycerol, sodium oleate,
water for injections.
Therapeutic indications NuTRIflex® Lipid peri/NuTRIflex Lipid plus: Supply of energy, essential fatty
acids, amino acids, electrolytes and fluids in the setting of parenteral nutrition of patients in states of
mild to moderately severe catabolism when oral or enteral nutrition is impossible, insufficient or contraindicated.
Therapeutic indications NuTRIflex® Lipid special: Supply of energy, essential fatty acids, amino acids,
electrolytes and fluids in the setting of parenteral nutrition of patients in states of moderate to severe
catabolism when oral or enteral nutrition is impossible, insufficient or contraindicated.
Therapeutic indications NuTRIflex® Lipid plus without electrolytes/NuTRIflex® Lipid special without
electrolytes: Supply of energy, essential fatty acids, amino acids and fluids in the setting of parenteral
nutrition of patients in states of moderately severe catabolism when oral or enteral nutrition is impossible,
insufficient or contraindicated.
Posology and method of administration: The dosage is adapted to the patients’ individual requirements.
It is recommended that NuTRIflex® Lipid peri/plus/special/plus without electrolytes/special without electrolytes be administered continuously. A stepwise increase of the infusion rate over the first 30 minutes up
to the desired infusion rate avoids possible complications.
Paediatric population: Newborn infants, infants and toddlers less than two years of age: NuTRIflex® Lipid
peri/plus/special/plus without electrolytes/special without electrolytes is contraindicated in newborn infants,
infants and toddlers < 2 years of age. Children from 2 to 13 years age: The dosage should be individually
adapted according to age, developmental stage and illness. For calculation of dosage account must be taken
of the hydration status of the paediatric patient. For children, it might be necessary to start the nutritional
therapy with half of the target dosage. The dosage should be increased stepwise according to the individual
metabolic capacity up the maximum dosage.
Patients with renal/hepatic impairment: The doses should be adjusted individually in patients with hepatic
or renal insufficiency.
Duration of treatment NuTRIflex® Lipid peri: The duration of treatment for the indications stated should
not exceed 7 days.
Duration of treatment NuTRIflex® Lipid plus/special/plus without electrolytes/special without
electrolytes: The duration of treatment for the indications stated is not limited. During long-term administration it is necessary to provide for appropriate supply of trace elements and vitamins.
Method of administration NuTRIflex® Lipid peri: Intravenous use. Infusion into a peripheral or central vein.
Method of administration NuTRIflex® Lipid plus/special/plus without electrolytes/special without
electrolytes: Intravenous use. For central venous infusion only.
Contraindications: This products must not be administered in the presence of the following conditions:
hypersensitivity to the active substances, to egg, peanut or soya protein or to any of the excipients, congenital disorders of amino acid metabolism, severe hyperlipidaemia, hyperglycaemia not responding to insulin
doses of up to 6 units insulin/hour, acidosis, intrahepatic cholestasis, severe hepatic insufficiency, severe
renal insufficiency in absence of renal replacement therapy, aggravating haemorrhagic diatheses, acute
thromboembolic events, lipid embolism, on account of its composition NuTRIflex® Lipid peri/plus/special/
plus without electrolytes/special without electrolytes must not be used in newborn infants, infants and
toddlers under 2 years of age.
General contraindications to parenteral nutrition include: unstable circulatory status with vital threat
(states of collapse and shock), acute phases of cardiac infarction and stroke, unstable metabolic condition
(e.g. severe postaggression syndrome, coma of unknown origin), inadequate cellular oxygen supply, disturbances of the electrolyte and fluid balance, acute pulmonary oedema, decompensated cardiac insufficiency.
Special warnings and precautions for use: Caution should be exercised in cases of increased serum osmolarity. Too rapid infusion can lead to fluid overload with pathological serum electrolyte concentrations,
hyperhydration and pulmonary oedema. Any sign or symptom of anaphylactic reaction (such as fever,
shivering, rash or dyspnoea) should lead to immediate interruption of the infusion. The serum triglyceride
concentration should be monitored when infusing NuTRIflex® Lipid peri/plus/special/plus without electrolytes/special without electrolytes. Depending on the patient’s metabolic condition, occasional hypertriglyceridaemia may occur. If the plasma triglyceride concentration rises to above 3 mmol/l during administration of lipids, it is recommended that the infusion rate be reduced.
Should the plasma triglyceride concentration remain above 3 mmol/l, the administration should be stopped
until the level normalises. Like all solutions containing carbohydrates, the administration of NuTRIflex®
Lipid peri/plus/special/plus without electrolytes/special without electrolytes can lead to hyperglycaemia.
The blood glucose level should be monitored. If there is hyperglycaemia, the rate of infusion should be
reduced or insulin should be administered. If the patient is receiving other intravenous glucose solutions
concurrently, the amount of additionally administered glucose has to be taken into account. An interruption
of administration of the emulsion may be indicated if the blood glucose concentration rises to above
14 mmol/l (250 mg/dl) during administration. Intravenous infusion of amino acids is accompanied by
increased urinary excretion of the trace elements, especially copper and, in particular, zinc. This should be
considered in the dosing of trace elements, especially during long-term intravenous nutrition. Refeeding
or repletion of malnourished or depleted patients may cause hypokalaemia, hypophosphataemia and
hypomagnesaemia. Adequate supplementation of electrolytes according to deviations from normal values
is necessary. NuTRIflex® Lipid peri/plus/special/plus without electrolytes/special without electrolytes should
not be given simultaneously with blood in the same infusion set due to the risk of pseudoagglutination.
Elderly patients: Basically the same dosage as for adults applies, but caution should be exercised in patients
suffering from further diseases like cardiac insufficiency or renal insufficiency that may frequently be
associated with advanced age.
Patients with diabetes mellitus, impaired cardiac or renal function: Like all large-volume infusion
solutions, NuTRIflex® Lipid peri/plus/special/plus without electrolytes/special without electrolytes should
be administered with caution to patients with impaired cardiac or renal function. There is only limited
experience of its use in patients with diabetes mellitus or renal failure.
Patients with impaired lipid metabolism: NuTRIflex® Lipid peri/plus/special/plus without electrolytes/
special without electrolytes should be administered cautiously to patients with disturbances of lipid metabolism, e.g. renal insufficiency, diabetes mellitus, pancreatitis, impaired hepatic function, hypothyroidism
(with hypertriglyceridaemia) and sepsis. If NuTRIflex® Lipid peri/plus/special/plus without electrolytes/
special without electrolytes is given to patients with these conditions, monitoring of serum triglycerides
is necessary. The presence of hypertriglyceridaemia 12 hours after lipid administration also indicates
a disturbance of lipid metabolism. Disturbances of the fluid, electrolyte or acid-base balance, must be
corrected before the start of infusion. Controls of the serum electrolytes, the water balance, the acid-base
balance, and – during long-term administration – of blood cell counts, coagulation status and hepatic
function are necessary. Substitution of electrolytes, vitamins and trace elements may be necessary as
required. As NuTRIflex® Lipid peri/plus/special contains zinc and magnesium, care should be taken when it
is coadministered with solutions containing these elements. For NuTRIflex® Lipid plus without electrolytes/
special without electrolytes: These products do not contain electrolytes. Therefore sufficient amounts of
electrolytes must be administered together with NuTRIflex® Lipid plus without electrolytes/special without
electrolytes according to the patients’ requirements. A sufficient potassium substitution has to be ensured.
It may be necessary to supply also trace elements and vitamins. Close monitoring of serum electrolytes is
mandatory. This applies especially for refeeding or repletion of malnourished or depleted patients who are
at special risk to develop hypokalaemia, hypophosphataemia and hypomagnesaemia. NuTRIflex® Lipid plus
without electrolytes/special without electrolytes contain less than 1 mmol sodium (23 mg) per multichamber
bag, i.e. it is essentially ‘sodium-free’.
As with all intravenous solutions strict aseptic precautions are necessary for the infusion of NuTRIflex® Lipid
peri/plus/special/plus without electrolytes/special without electrolytes.
Pregnancy and lactation: There are no or limited amount of data from the use of NuTRIflex® Lipid peri/
plus/special/plus without electrolytes/special without electrolytes in pregnant women. Animal studies
are insufficient with respect to reproductive toxicity (see section 5.3). Parenteral nutrition may become
necessary during pregnancy. Nutriflex Lipid peri should only be given to pregnant women after careful
consideration. Components/metabolites of NuTRIflex® Lipid peri/plus/special/plus without electrolytes/
special without electrolytes are excreted in human milk, but at therapeutic doses no effects on the breastfed newborns/infants are anticipated. Nevertheless, breast-feeding is not recommended for mothers on
parenteral nutrition.
Undesirable effects: The following listing includes a number of systemic reactions that may be associated
with the use of NuTRIflex® Lipid peri/plus/special/plus without electrolytes/special without electrolytes.
Under conditions of correct use, in terms of dosing monitoring, observation of safety restrictions and
instructions, most of them are rare (≥1/10,000 to < 1/1,000).
Undesirable effects are listed according to their frequencies as follows:
Very common (≥ 1/10)
Common
(≥ 1/100 to < 1/10)
Uncommon (≥ 1/1,000 to < 1/100)
Rare
(≥ 1/10,000 to < 1/1,000)
Very rare
(< 1/10,000)
Not known (frequency cannot be estimated from the available data)
Blood and lymphatic system disorders: Rare: Hypercoagulation
Immune system disorders: Rare: Allergic reactions (e.g. anaphylactic reactions, dermal eruptions, laryngeal,
oral and facial oedema)
Metabolism and nutrition disorders: Very rare: Hyperlipidaemia, hyperglycaemia, metabolic acidosis, ketoacidosis. The frequency of these undesirable effects is dose-dependent and may be higher under the
condition of absolute or relative lipid overdose.
Nervous system disorders: Rare: Drowsiness
Vascular disorders: Rare: Hypertension or hypotension, flush
Respiratory, thoracic and mediastinal disorders: Rare: Dyspnoea, cyanosis
Gastrointestinal disorders: Uncommon: Nausea, vomiting, loss of appetite
Skin and subcutaneous tissue disorders: Rare: Erythema
General disorders and administration site conditions: Rare: Headache, elevated body temperature, sweating,
feeling cold, chills, pain in the back, bones, chest and lumbar region; Very rare: Fat overload syndrome
NuTRIflex® Lipid peri: Common: After a few days, vein irritation, phlebitis or thrombophlebitis may occur.
If signs of vein wall irritation, phlebitis or thrombophlebitis occur, change of the infusion site should be
considered. Should adverse reactions occur or should the triglyceride level rise to above 3 mmol/l during
infusion, the infusion should be stopped or, if necessary, continued at a reduced dosage.
If the infusion is restarted, the patient should be carefully monitored, especially at the beginning, and
serum triglycerides should be determined at short intervals.
B. Braun Melsungen AG, 34209 Melsungen, Germany. Please refer to national approved Summary of
Product Information, before prescribing. Status of latest information: April 2012. Registered Product
information may differ from country to country. Not all products are marketed in all countries.
69
Clinical Nutrition
NuTRIflex® Omega
Composition
NuTRIflex® Omega plus emulsion for infusion/NuTRIflex® Omega special emulsion for infusion (mixed and
ready for use 1.250 ml).
Active ingredients of:
NuTRIflex® Omega plus emulsion for infusion/NuTRIflex® Omega special emulsion for infusion. Glucose
monohydrate 165.0 g/198.0 g, equivalent to anhydrous glucose 150.0 g/180.0 g, Sodium dihydrogen
2.340 g/3.120 g, Zinc acetate dehydrate 6.580 mg/8.78 mg, Medium-chain triglycerides 25.0 g/25.0 g,
Soya-bean oil refined 20.0 g/20.0 g, Omega-3-acid triglycerides 5.0 g/5.0 g, Isoleucine 2.82 g/4.11 g,
Leucine 3.76 g/5.48 g, Lysine hydrochloride 3.41 g/4.98 g, equivalent to Lysine 2.73 g/3.98 g, Methionine
2.35 g/3.42 g, Phenylalanine 4.21 g/6.15 g, Threonine 2.18 g/3.18 g, Tryptophan 0.68 g/1.00 g, Valine 3.12 g/
4.51 g, Arginine 3.24 g/4.73 g, Histidine hydrochloride monohydrate 2.03 g/2.96 g, equivalent to Histidine
1.50 g/2.19 g, Alanine 5.82 g/8.49 g, Aspartic acid 1.80 g/2.63 g, Glutamic acid 4.21 g/6.14 g, Glycine
1.98 g/2.89 g, Proline 4.08 g/5.95 g, Serine 3.60 g/5.25 g. Sodium hydroxide 0.976 g/1.464 g, Sodium
chloride 0.503 g/0.473 g, Sodium acetate trihydrate 0.277 g/0.313 g, Potassium acetate 3.434 g/4.611 g,
Magnesium acetate tetrahydrate 0.858 g/1.137 g, Calcium chloride dehydrate 0.588 g/0.779 g, Amino
acid content (g) 48/71.8, Nitrogen content (g) 6.8/10, Carbohydrate content (g) 150/180, Lipid content (g)
50/50, Electrolytes (mmol): Sodium 50/67, Potassium 35/47, Magnesium 4.0/5.3, Calcium 4.0/5.3, Zinc
0.03/0.04, Chloride 45/60, Acetate 45/60, Phosphate 15/20, Energy in the form of lipid [kJ (kcal)] 1990
(475)/1990 (475), Energy in the form of carbohydrate [kJ (kcal)] 2510 (600)/3015 (720), Energy in the
form of amino acids [kJ (kcal)] 800 (190)/1170 (280), Non-protein energy [kJ (kcal)] 4500 (1075)/5005
(1195), Total energy [kJ (kcal)] 5300 (1265)/6175 (1475), Osmolality (mOsm/kg) 1540/2090, pH 5.0 - 6.0/
5.0 - 6.0, Theoretical osmolarity (mOsm/l) 1215.
List of excipients:
Citric acid monohydrate, Egg lecithin, Glycerol, Sodium oleate, all-rac-a-tocopherol, Sodium hydroxide for
pH adjustment, Water for injections.
Therapeutic indications:
Supply of energy and essential fatty acids including omega-3 and omega-6 fatty acids, amino acids, electrolytes and fluids in the setting of parenteral nutrition of patients in states of moderate to severe catabolism when oral or enteral nutrition is impossible, insufficient or contraindicated.
Posology and method of administration:
The dosage is adapted to the patients’ individual requirements. It is recommended that NuTRIflex® Omega
be administered continuously. A stepwise increase of the infusion rate over the first 30 minutes up to the
desired infusion rate avoids possible complications. Paediatric population NuTRIflex® Omega is contraindicated in newborn infants, infants and toddlers < 2 years of age. Safety and efficacy in children > 2 years
and adolescents have not been established. Patients with renal/hepatic impairment: The doses should be
adjusted individually in patients with hepatic or renal insufficiency. Duration of treatment: The duration of
treatment for the indications stated is not limited. During long-term administration of NuTRIflex® Omega
plus it is necessary to provide for appropriate supply of trace elements and vitamins. Method of administration: Intravenous use. For central venous infusion only.
Contraindications:
This product must not be administered in the presence of the following conditions: hypersensitivity to the
active substances, to egg, fish, peanut or soya protein or to any of the excipients, congenital disorders of
amino acid metabolism, severe hyperlipidaemia, hyperglycaemia not responding to insulin doses of up to
6 units insulin/hour, acidosis, intrahepatic cholestasis, severe hepatic insufficiency, severe renal insufficiency
in absence of renal replacement therapy, aggravating haemorrhagic diatheses, acute thrombo-embolic
events, lipid embolism, on account of its composition NuTRIflex® Omega must not be used in newborn
infants, infants and toddlers under 2 years of age. General contraindications to parenteral nutrition include:
Tracutil®
Composition
1 ampoule of 10 ml contains
Active ingredients:
6.958 mg
Iron (II) chlorid · 4 H2O
(equivalent to 35.0 µmol of iron)
Zinc chloride, anhydrous
6.815 mg
(equivalent to 50.0 µmol of zinc)
1.979 mg
Manganese (II) chloride · 4 H2O
(equivalent to 10.0 µmol of manganese)
2.046 mg
Copper (II) chloride · 2 H2O
(equivalent to 12.0 µmol of copper)
0.053 mg
Chromium (III) chloride · 6 H2O
(equivalent to 0.2 µmol of chromium)
0.0242 mg
Sodium molybdate · 2 H2O
(equivalent to 0.1 µmol of molybdenum)
0.0789 mg
Sodium selenite · 5 H2O
(equivalent to 0.3 µmol of selenium)
Sodium fluoride
1.260 mg
(equivalent to 30.0 µmol of fluoride)
Potassium iodide)
0.166 mg
(equivalent to 1.0 µmol of iodide)
Excipients:
Hydrochloric acid, water for injections.
Therapeutic indications
Provision of basic trace element requirements
during long-term Parenteral Nutrition in adult
patients.
Contra-indications
Increased serum levels of the trace elements
contained in Tracutil®. Tracutil® should not be administered to newborn infants, infants and children.
Notes
unstable circulatory status with vital threat (states of collapse and shock), acute phases of cardiac infarction
and stroke, unstable metabolic condition (e.g. severe postaggression syndrome, coma of unknown origin),
inadequate cellular oxygen supply, disturbances of the electrolyte and fluid balance, acute pulmonary
oedema, decompensated cardiac insufficiency.
Special warnings and precautions for use:
Caution should be exercised in cases of increased serum osmolarity. Disturbances of the fluid, electrolyte
or acid-base balance, must be corrected before the start of infusion. Too rapid infusion can lead to fluid
overload with pathological serum electrolyte concentrations, hyperhydration and pulmonary oedema. Any
sign or symptom of anaphylactic reaction (such as fever, shivering, rash or dyspnoea) should lead to immediate
interruption of the infusion. The serum triglyceride concentration should be monitored when infusing
NuTRIflex® Omega. Depending on the patient’s metabolic condition, occasional hypertriglyceridaemia may
occur. If the plasma triglyceride concentration rises to above 3 mmol/l during administration of lipids, it is
recommended that the infusion rate be reduced. Should the plasma triglyceride concentration remain
above 3 mmol/l, the administration should be stopped until the level normalises. Like all solutions containing carbohydrates, the administration of NuTRIflex® Omega can lead to hyperglycaemia. The blood
glucose level should be monitored. If there is hyperglycaemia, the rate of infusion should be reduced or
insulin should be administered. If the patient is receiving other intravenous glucose solutions concurrently,
the amount of additionally administered glucose has to be taken into account. An interruption of administration of the emulsion may be indicated if the blood glucose concentration rises to above 14 mmol/l
(250 mg/dl) during administration. Intravenous infusion of amino acids is accompanied by increased urinary
excretion of the trace elements, especially copper and, in particular, zinc. This should be considered in the
dosing of trace elements, especially during long-term intravenous nutrition. Refeeding or repletion of
malnourished or depleted patients may cause hypokalaemia, hypophosphataemia and hypomagnesaemia.
Adequate supplementation of electrolytes according to deviations from normal values is necessary. NuTRIflex®
Omega should not be given simultaneously with blood in the same infusion set due to the risk of pseudoagglutination. Controls of the serum electrolytes, the water balance, the acid-base balance and – during
long-term administration – of blood cell counts, coagulation status and hepatic function are necessary.
Substitution of electrolytes, vitamins and trace elements may be necessary as required. As NuTRIflex®
Omega contains zinc and magnesium, care should be taken when it is co-administered with solutions
containing these elements. As with all intravenous solutions strict aseptic precautions are necessary for
the infusion of NuTRIflex® Omega. Paediatric population: There is as yet no clinical experience of the use
of NuTRIflex® Omega in children and adolescents. Elderly patients: Basically the same dosage as for adults
applies, but caution should be exercised in patients suffering from further diseases like cardiac insufficiency
or renal insufficiency that may frequently be associated with advanced age. Patients with diabetes mellitus,
impaired cardiac or renal function: Like all large-volume infusion solutions, NuTRIflex® Omega should be
administered with caution to patients with impaired cardiac or renal function. There is only limited experience of its use in patients with diabetes mellitus or renal failure. Patients with impaired lipid metabolism:
NuTRIflex® Omega should be administered cautiously to patients with disturbances of lipid metabolism,
e.g. renal insufficiency, diabetes mellitus, pancreatitis, impaired hepatic function, hypothyroidism (with
hypertriglyceridaemia) and sepsis. If NuTRIflex® Omega is given to patients with these conditions, monitoring of serum triglycerides is necessary. The presence of hypertriglyceridaemia 12 hours after lipid
administration also indicates a disturbance of lipid metabolism. Special warnings/precautions regarding
excipients: Vitamin E (a-tocopherol) can interfere with the effect of vitamin K in clotting factor synthesis.
This should be considered in patients with blood coagulation disorders or suspected vitamin K deficiency
and in patients treated with coumarin anticoagulants. Interference with laboratory tests: The fat content
may interfere with certain laboratory measurements (e.g. bilirubin, lactate dehydrogenase, oxygen saturation)
if blood is sampled before fat has been adequately cleared from the blood stream.
B. Braun Melsungen AG, 34209 Melsungen, Germany, Please refer to local Summary of Product
Information, before prescribing. Status of latest information: February 2013
Notes:
Care is to be taken in cases of impaired liver or
kidney function which requires a check of the
serum concentrations and, where appropriate,
reduction of the dose.
Caution is also necessary in case of Wilson’s disease
and disturbed iron storage (i.e. haemosiderosis or
haemochromatosis) because copper and iron supplementation may cause an additional accumulation of these elements in such cases.
Special warnings and special precautions for use
In case of biliary tract disease administration of
Tracutil® may lead to an accumulation of copper
and manganese. Chromium deficiency leads to a
decrease in glucose tolerance, which improves
again after chromium supplementation. For this
reason, patients suffering from insulin-dependent
diabetes mellitus and chromium deficiency may
require a reduction in the amount of insulin they
receive during administration of Tracutil®.
Use in pregnancy and lactation:
There is no data available on administration during
pregnancy or in the lactation period. The benefits
must therefore be carefully weighed against the risks.
Undesirable effects
Individual cases of anaphylactic reactions to
parenterally administered iron have been reported.
Dispensing classification
Subject to medical prescription.
70
71
The NuTRIscreen-App:
B. Braun Melsungen AG | Hospital Care | 34209 Melsungen | Germany
Tel. +49 5661 71-0 | www.bbraun.com | www.nutrition-partner.com
Nr. 606 4181

Your Nutrition Partner to improve Life

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