Clinical Nutrition General Brochure

Your Nutrition Partner to improve Life
Clinical Nutrition
Your nutrition partner to improve life
The important role of adequate nutrition during hospital stay is well documented by several different studies. These studies suggest that up to 60% of patients in hospitals are suffering from malnutrition which is often the cause for serious complications such as an increasing risk of sepsis, infection, inflammation or organ failure. The consequences of these complications are reduced wound healing leading to a significantly uprated morbidity and mortality. To avoid these consequences an appropriate nutritional therapy is an indispensable condition especially for critically ill patients. The right nutrition system will not only minimize the risk of morbidity and mortality by strengthening your patients immune system and organ functions, but also lead to a sooner recovery. This will reduce the duration of hospital stay and in the end the costs for treatment. Nowadays clinical nutrition is widely accepted in clinical practice. The lifesaving characteristics of the adequate nutrition can not be denied so it became an important part of the overall treatment package.
There are different ways of clinical nutrition: enteral, parenteral or a combination of both. The right way of clinical nutrition always depends on the patients gut function and his general physiological condition. The determination of the nutritional status should be part of each physical examination in order to identify risk patients to evaluate their risk and to define an individual nutrition therapy. The NuTRIscreen-App includes different screening tools, such as "NRS-2002" (Nutrition Risk Score), the "MUST" (Malnutrition Universal Screening Tool) and the "SGA" (Subjective Global Assessment). The NuTRIscreen-App is available at the App Store.
The NuTRIscreen-App:
References: 1. Wilson et al. Prevalence and causes of undernutrition in medical outpatients. Am J Med 1998; 104; 56-63 2. Norman et al. Clin Nutr (2008) 27; 5-15 3. Stratton et al. (2003) Wallingford: CAB International 4. Neumayer et al. J Surg Res (2001) 95; 73-77 5. Lawson (2002) Clin Nutr (2003) 22(1); 39-46
Clinical Nutrition
Enteral nutrition support is needed if the patient is unable, unwilling or not allowed to take adequate nutrition from normal food. Use of the gastrointestinal tract for nutrition support allows a physiological utilization of nutrients. Parenteral nutrition on the other hand bypasses the gastrointestinal tract and is given intravenously, either via peripheral or central venous line. Our ready-to-use systems offer standardized nutrition regimes, required by most of enterally or parenterally fed patients. Patient-tailored prescriptions are only necessary in specific clinical situations. Therefore the wide product range and the possibility of making additions allows a highly flexible adaptation to specific patient needs.
16 14 12 10
days
Consequences of malnutrition2,3:
n
Increased hospital stay Increased morbidity and mortality Increase in infectious complications Reduced wound healing
40
30
8 6 4 2 0
no adequate nutrition early and sufficient nutrition
20
10
0
control nutrition supplement
1060 % malnutrition based on 5.120 patients1
Average length of hospital stay in surgical patients in relation to nutritional support 4
Complication rate in orthopedic patients 5 3
Parenteral and enteral ...
Nutritional care is a concept which includes several aspects and these must be managed in a seamless way to ensure that the right patients receive the right nutritional support at the right time and in the right place. It is fundamental that nutritional care is based on each patient's individual nutritional requirements and preferences. Any patient who is undernourished or at risk for undernutrition should have a nutritional care plan. The integrated concept of nutritional support offered by B. Braun enteral and parenteral nutrition going hand in hand creates a solid platform for different kinds of nutritional treatments, allowing health care specialists to choose from a wide product range, to meet the fundamental requirements of the body.
Parenteral Nutrition The parenteral nutrition therapy can be realized with premixed convenience solutions or by patient-tailored nutrition. The standardized parenteral nutrition (NuTRIflex System) is suitable for most of the parenterally fed patients, and has significant advantages by preventing therapeutical errors and reducing work load and total costs for the preparation of nutritional regimens.6 For specific clinical situations (e.g. patients with severe metabolic derangements or organ dysfunctions) and for neonatology, a patient-tailored nutrition therapy based on different single nutritional solutions is required.
6. Pichard et al. Clin. Nutr. (2000) 19(4); 245-251
Clinical Nutrition
... it is all about nutrition
Enteral Nutrition B. Braun offers a wide range of enteral nutrition products that cover different indications and routes of application. Enteral nutrition allows a physiological utilisation of nutrients and is believed to promote gut function and prevent translocation of intestinal bacteria. However, choosing the right feeding method and formula to achieve quality nutritional care is a daily challenge of health care practitioners and dietitians around the world. There are different ways to get access to the gastrointestinal tract, whatever routes of application you are looking for.
B. Braun offers a broad range of pump or gravity application sets as well as naso-gastric or naso-intestinal tubes. The formulas of enteral nutrition products are a ready to administer mixture of important nutrients like proteins, carbohydrates, fats, vitamins and minerals that can be used as a sole source of nutrition or as a supplement. The composition can be a standard formula, reflecting the nutrition needs of a healthy patient, or adapted to a specific disease and / or digestive disorder (disease specific formula). B. Braun formulas are a safe and effective source of nutrition reflecting the requirements of patients and health care professionals alike.
Binding forward-looking technology
Successful therapy requires adequate clinical nutrition which is why we consider parenteral and enteral nutrition as an integral part of modern uid management systems.
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 nurses 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. 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.
Your benets:
n
Protect your budgets by using Infusomat Space also for enteral nutrition Prevent mix-up of enteral lines and IV access ports Reduce nurses workloads and the total cost of preparation with ready-to-use 2- or 3-chamber bags End messy dripping of sticky fluids with PrimeStop No additional training required
Enteral Nutrition Parenteral Nutrition Insulin Pump
Space Control User Interface
Clinical Nutrition
with highest treatment quality

Automatic consideration of nutrition data
1. Blood sampling and analysis
Automatic insulin application
2. Input of glucose value into SpaceControl
3. Conrmation of suggested insulin rate
Automatic calculation of appropriate insulin rate and next sampling time
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.
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.
Glucose (mmol/l)
B. Braun Space GlucoseControl:

B. Braun Space GlucoseControl
n
20
Conventional Glucose Control
The solution to achieve safe and reproducible blood glucose control Automatic Integration of Nutrition More safety in daily clinical workflow Optimized workflow and simplified treatment decision for more safety in daily use
15
10
Time (hours)
Strict Glucose Control within a range of 4.46.1 mmol/l (80110 mg/dl) 7
The NuTRIflex system for your convenience

Convenience with Safety
The NuTRIflex System is the ready-to-infuse multi chamber bag system for Total Parenteral Nutrition (TPN). 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 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. 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 including a MCT/LCT lipid emulsion.
Nutriflex 2-chamber bag
NuTRIflex Lipid 3-chamber bag
Amino Acid Lipid
Glucose
Glucose
Amino Acid
Latex-free PVC-free
Port system n Low risk for needle stick injury n Easy to grip and firm fitting n No leakage after removal n Stable ports made of hard plastic n Self-sealing
Latex-free PVC-free DEHP-free
Parenteral Nutrition
Mix add mix infuse

The steps: Safety aspect After adding the additives to the clear solution, a visual check is possible.
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.
4. Finally, mix thoroughly before inserting the giving set.
User benefits
n
Increase patient safety, through visual check Environmental and patient-friendly bag material (no PVC, no DEHP and no latex) Convenient, cost-effective and safe
2-chamber bags
Nutriflex Sterile solution for intravenous nutrition containing amino acids, carbohydrates and electrolytes in a 2-chamber bag. Nutriex
n
PN regimens for individual fat requirements
Flexibility in adding optional lipid emulsions such as Lipoplus2 or Lipofundin MCT/LCT1
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 situations with high nutritional requirements In All Nutriflex - 2-chamber bags n Flexibility to choose and add the fat component (e.g. Lipoplus, Lipofundin)
Characteristics n Different balanced regimens for peripheral and central venous application n Reliable source of protein and calories n Supplies electrolytes n Easy and safe handling n Flexibility to add fat easily to complete parenteral nutrition from one bag n 24-month shelf life at room temperature 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
1. Trade name in some countries: Medialipide, Vasolipid 2. Trade name in some countries: Lipidem
Composition 1000 ml Amino acids Nitrogen* Glucose Electrolytes Total energy Non-Protein energy Presentations** kcal kcal ml g g g
Nutriflex peri 40 5.7 80 + 480 320 1000, 2000
Nutriflex basal 32 4.6 125 + 630 500 1000, 2000
Nutriflex plus 48 6.8 150 + 790 600 1000, 2000
Nutriflex special 70 10.0 240 + 1240 960 1000, 1500
* due to the specific amino acid pattern, 14 g N 100 g amino acids; ** may differ from country to country
10
Parenteral Nutrition Clinical
Nutriflex global portfolio overview*
Nutriflex 2-chamber bag Volume (ml) Amino acids (g) Nitrogen (g) Glucose (g) Total energy (kcal) Osmolarity (mOsm/l) Content Electrolytes (mmol) Sodium Potassium Calcium Magnesium Phosphate Chloride Acetate 27 15 2.5 4.0 5.7 31.6 19.5 1000 40 5.7 80 480 900
peri 2000 80 11.4 160 960 900 54 30 5.0 8.0 11.4 63.2 39 1000 32 4.6 125 630 1150 49.9 30 3.6 5.7 12.8 50 35
basal 2000 64 9.2 250 1255 1150 99.8 60 7.2 11.4 25.6 100 70 1000 48.1 6.8 150 790 1400 37.2 25 3.6 5.7 20.0 35.5 22.9
plus 2000 96.2 13.6 300 1580 1400 74.2 50 7.2 11.4 40.0 71 45.8 1000 70 10 240 1240 2100 40.5 25.7 4.1 5.0 14.7 49.5 22
special 1500 105 15 360 1860 2100 60.8 38.6 6.2 7.5 22.1 74.3 33
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 manufacturers recommendation. *Not all versions and bag volumes will be marketed in each country.
11
3-chamber bags
NuTRIflex Lipid Sterile solution for IV nutrition containing amino acids, carbohydrates and lipids in a 3-chamber bag available with and without electrolytes. NuTRIflex Lipid
n
Easy and safe parenteral nutrition Metabolic advantages through simultaneous administration of nutrients Compatibility and stability data offer safe limits for the addition of further required minerals, vitamins and trace elements The only 3-chamber bag with MCT/LCT1 lipid emulsion Reduces work load and total cost for TPN NuTRIflex Lipid special 625 ml - as ICU starter bag for combined enteral/parenteral nutrition as basic all-in-one bag for children (>2 years)
Product range NuTRIflex Lipid peri n Peripheral parenteral nutrition n Supplementary nutrition n combination with enteral nutrition In n Specially designed for Low Glucose Nutrition (LGN) Therapy (peripheral and central venous) NuTRIflex Lipid plus n Central venous parenteral nutrition for moderately increased requirements n Easy to calculate: 1 ml = 1 kcal NuTRIflex Lipid special n volume-restricted parenteral nutrition is required If n situations with high nutritional demands In n 625 ml version as ICU starter bag and for combined enteral/parenteral nutrition NuTRIflex Lipid without electrolytes (plus and special) n For individualized electrolyte administration
1. Trade name in some countries: Medialipide, Vasolipid
Characteristics n Allows the simultaneous administration of required nutrients out of one container n Contains MCT/LCT1 lipid emulsion n Electrolyte-containing versions cover the basic needs for electrolytes and zinc n Electrolyte-free versions for individualized electrolyte administration n Easy and safe handling n 24-month shelf life at room temperature Accessories Light Protection Cover: NuTRIflex Lipid 1250 ml, 1875 ml, 2500 ml (Art. No. 211 2112) NuTRIflex Lipid 625 ml (Art. No. 212 9035)
Composition 1250 ml Amino acids Nitrogen* Glucose Lipids (MCT/LCT) Electrolytes Total energy Non-Protein calories Presentations** kcal kcal ml g g g g
NuTRIflex Lipid peri 40 5.7 80 50 + 955 795 1250, 1875, 2500
NuTRIflex Lipid plus

without electrolytes
NuTRIflex Lipid plus 48 6.8 150 50 + 1265 1075 1250, 1875, 2500
NuTRIflex Lipid special

without electrolytes
NuTRIflex Lipid special 71.8 10 180 50 + 1475 1195 625, 1250, 1875, 2500
48 6.8 150 50 1265 1075 1250, 1875, 2500
71.8 10 180 50 1475 1195 1250, 1875, 2500
* due to the specific amino acid pattern, 14 g N 100 g amino acids; ** may differ from country to country
12
NuTRIflex Lipid global portfolio overview*

2500 ml NuTRIflex Lipid Special in a 625 ml bag 1875 ml This unique size is especially suited for: n Patients requiring an incremental increase in TPN during their first days on ICU n Combining enteral and parenteral nutrition n Children (> 2 years) as a basic all-in-one bag for convenient TPN
1250 ml
625 ml
NuTRIflex Lipid 3-chamber bag Volume (ml) Amino acids (g) Nitrogen (g) Glucose (g) Lipids (g) Total energy (kcal) Osmolarity (mOsm/l) Content Electrolytes (mmol) Sodium Potassium Calcium Magnesium Phosphate Chloride Acetate Zinc 50 30 3.0 3.0 7.5 48 40 0.03 1250 40 5.7 80 50 955 840
peri 1875 60 8.6 120 75 1435 840 75 45 4.5 4.5 11.25 72 60 0.045 2500 80 11.4 160 100 1910 840 100 60 6.0 6.0 15.0 96 80 0.06 1250 48 6.8 150 50 1265 1215 50 35 4.0 4.0 15.0 45 45 0.03
plus
a)
special 2500 96 13.6 300 100 2530 1215 100 70 8.0 8.0 30.0 90 90 0.06 625 35.9 5 90 25 740 1545 33.5 23.5 2.65 2.65 10.0 30 30 0.02 1250 71.8 10 180 50 1475 1545 67 47 5.3 5.3 20.0 60 60 0.04
a)
1875 72 10.2 225 75 1900 1215 75 52.5 6.0 6.0 22.5 67.5 67.5 0.045
1875 107.7 15 270 75 2215 1545 100.5 70.5 7.95 7.95 30.0 90 90 0.06
2500 143.6 20 360 100 2950 1545 134 94 10.6 10.6 40.0 120 120 0.08
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 manufacturers recommendation. a) NuTRIflex Lipid plus and special also exist as electrolyte-free versions (e-fr. plus/special: 1055/1330 mOsm/l). *Not all versions and bag volumes will be marketed in each country.
13
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. 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.
Against this background, the NuTRIflex System allows hospital compounding services to focus on those 10%20% critically ill patients requiring patient-tailored nutrition support.
14
for parenteral nutrition
Compounding of a Nutrimix mixing bag
Product range n Aminoplasmal B. Braun: Amino acid solutions for parenteral nutrition n Aminoplasmal 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
n
Wide range of product versions for patient-tailored TPN Excellent stability in TPN admixtures Well balanced MCT/LCT lipid emulsion with -3 fatty acids
15
Amino acids
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.
Aminoplasmal B. Braun
n
Aminoplasmal Hepa
n
Maintenance of equilibrium of amino acids in blood1 Excellent stability in TPN mixtures2
Normalization of cirrhosis-induced amino acid imbalances Improved clinical situation in hepatic encephalopathy
1. Berard MP, Hankard R, Cynober L; Amini acid metabolism during parenteral nutrition in healthy volunteers: evaluation of a new amino acid solution; Clin Nutr 2001 20(5) 407-414 2. Driscoll DF; Physicochemical stability of highly concentrated all-in-one mixtures intended for fluid restricted patients; Clin Nutr Vol 21, Supplement 1, Aug 2002
Allows to provide adequate protein supply to patients suffering from liver insufficiency
Characteristics n 5%, 10% and 15% amino acid concentrations n Balanced content of essential and non-essential amino acids n Amino acid pattern for patients > 2 years of age n Available also as electrolyte free versions n Very good stability in all-in-one mixtures n ompatible with Lipoplus3 and Lipofundin MCT/LCT4 C containing all-in-one mixtures n lectrolyte free versions do not contain chloride E
Characteristics n Specific amino acid pattern adapted to the specific needs of patients with liver insufficiency n High concentration of branched chain amino acids n Reduced aromatic amino acid and methionine content
3. Trade name in some countries: Lipidem 4. Trade name in some countries: Medialipide, Vasolipid
Composition 1000 ml Amino acids Nitrogen Electrolytes Energy Presentations*

* may differ from country to country
Aminoplasmal B. Braun 5% E g g kcal ml 50 8 + 200 250, 500, 1000
Aminoplasmal B. Braun 10% 10 % E 100 100 16 400 250, 500, 1000 +
Aminoplasmal 15 % 15 % E 150 150 24 600 500, 1000 +
Aminoplasmal Hepa 10 % 100 15.3 400 500
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Lipid emulsions
Lipofundin MCT/LCT 1 Fat emulsion for parenteral nutrition on the basis of medium and long chain 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. Lipoplus 2 or Lipidem New generation of lipid emulsion.
In addition to the well known characteristics of Lipofundin MCT/LCT 1, Lipoplus 2 has a well-balanced 3 : 6 ratio of 1: 2.7, achieved by adding highly purified fish oil -3 fatty acid triglycerides.
Lipofundin MCT/LCT1
n
Lipoplus2
n
Protects liver, lung and immune function Improves protein economy Superior stability improves safety One lipid emulsion for all patients Antioxidative protection to prevent peroxidative damages
Inflammation-modulating effects - reduced length of hospital stay3, 4 - improves oxygenation index4
2. Trade name in some countries: Lipidem 3. Wichmann et al. Crit Care Med 2007; 35, 700-706 4. Barbosa VM et al. Crit Care. 2010;14(1):R5. Epub 2010 Jan 19
Characteristics n Registered for use in neonates and children n For peripheral and central venous application n Excellent stability in TPN admixtures n Supplemented with Vitamin E
Characteristics n Contains MCT (coconut), LCT (soybean) and -3 triglycerides (fish oil) n For peripheral and central venous application n Excellent stability in all-in-one admixtures n Supplemented with vitamin E n The combination with Nutriflex 2-chamber bag allows quick, easy and stable preparation of all-in-one regimens
Lipofundin MCT/LCT 1 10 % 50 50 8 25 1022 85 20 100, 250, 500 Lipofundin MCT/LCT 1 20 % 100 100 12 25 1908 170 40 100, 250, 500 Lipoplus 20 % or Lipidem 20% 80 100 20 12 25 1910 190 30 100, 250, 500
Composition 1000 ml Soybean oil (LCT) MCT oil (coconut) Omega-3 acid triglycerides Egg yolk lecithin Glycerol Total energy
-Tocopherol (Vitamin E)
g g g g g kcal mg ml
Presentations*
17
Glucose solutions and trace elements

Glucose Braun Glucose solutions for providing energy (and fluid) in parenteral nutrition. Tracutil Trace element additive for adults. Used as a supplement in parenteral nutrition.
Glucose Braun
n
Tracutil
n
Essential energy source for organs and tissues
Supply of trace elements in parenteral nutrition of adults Compatible with a wide range of nutritional admixtures
Characteristics n Basic component in parenteral nutrition n Delivers approximately 4 kcal/g glucose n Wide range of concentrations available
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
Composition 1000 ml Glucose Energy Presentations*

Glucose g kcal 10% 100 400 20% 200 800 30% 300 1200 40% 400 1600 50% 500 2000 70 % 700 2800
Composition Tracutil Iron Zinc Manganese Copper Chromium Molybdenum Selenium Fluoride Iodide Presentation*
mg/10 ml 2 3.3 0.55 0.76 0.01 0.01 0.02 0.57 0.13 5 x 10 Ampoule
mol/10 ml 35 50 10 12 0.2 0.1 0.3 30 1
Ecoflac plus 500 ml; glass bottle 500 ml/1000 ml
18
Mixing bag
Nutrimix Traditional EVA mixing bag for easy and safe handling. Nutrimix Barrier Mixing Bag made of Multi-Layer Film to protect individual TPN preparations from oxidation. Nutrimix DC Dual chamber bag for stable separate storage of individual TPN preparation.
Nutrimix
n
Nutrimix Barrier
n
Nutrimix DC
n
100% Latex-free and DEHP-free, specially suitable for fat-containing TPN regimens Additive injection port with closure cap Detachable transfer set with lock connector Sterile outlet port with snap-off cap
100% Latex-free and DEHP-free, specially suitable for fat-containing TPN regimens Prolongs the stability of oxygensensitive compounds (e.g. vitamins) Ensures longer shelf life of compounded regimens Sterile outlet port with snap-off cap ensures easy and safe handling
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
Easy and safe handling
Sterile outlet port with snap-off cap to ensure easy and safe handling
Code No. (REF) 2112145 2112146 2112147 2112150 2112151 2112444 2112443 2112442 2112441 2112440 2112446 2112445 2112449
Presentations* Nutrimix 0.2/0 Nutrimix 0.5/0 Nutrimix 1/0 Nutrimix 2/3 Nutrimix 3/3 Nutrimix Barrier 3/0 Nutrimix Barrier 2/0 Nutrimix Barrier 1/0 Nutrimix Barrier 0,5/0 Nutrimix Barrier 0,2/0 Nutrimix Dual Chamber Bags (2500 + 500 ml) Nutrimix Dual Chamber Bags (1250 + 250 ml) Transfer Set
Volume 200 ml 500 ml 1000 ml 2000 ml 3000 ml 3000 ml 2000 ml 1000 ml 500 ml 200 ml 3000 ml 1500 ml 0
Filling lines 0 0 0 3 3 0 0 0 0 0 0 0 4
Units/Packages 1 1 1 1 1 5 5 5 5 5 1 1 1
Packages/Carton 25 25 25 25 25 25 25 40 50 50 25 25 25
19
Enteral Nutrition well-being and quality
20
Enteral Nutrition
through complete and balanced nutrition

Nutricomp liquids Liquid enteral nutrition diets like Nutricomp from B. Braun contain macro- and micronutrients adapted to the patients needs. Nutricomp fomulae come in different formats such as bags, plastic or glass bottles that can be applied as oral nutritional supplements or as tube feeding. Characteristics n Different formulae for individual needs of patients (standard and special diets) n Allows the adequate application of all macro- and micronutrients (nutritionally complete dietary food) n Fat from different sources, depending on patients needs n -3 fatty acids from fish oil n Fibre containing versions (most variations with prebiotic fibre) Variations high in energy and protein for patients with (combined protein-) energy malnutrition Diabetes product containing carbohydrates from starch, rich in monounsaturated fatty acids, fortified with antioxidants Versions containing MCT oil for patients with impaired lipid digestion Further products adapted to special metabolic conditions
Sip feed normal digestion and absorption
Tube feedTube feed normal digestion and absorption malabsorption and maldigestion
normal metabolic condition
pathological metabolism
high energy needs, bre contraindicated or inadvisable
bre contraindicated or inadvisable
rich in bre
high energy and protein needs, bre contraindicated or inadvisable
high energy and protein needs, rich in bre
fat malabsorption, steatorrhea
diabetes mellitus
hepatic disease
posttraumatic metabolic condition, respiratory failure
impaired immune function, stress, HIV-infection, cancer, chronic inammatory diseases
severe disorders of digestion and assimilation, pancreas failure
Nutricomp Nutricomp Nutricomp Nutricomp Standard Energy Drink Plus Standard Fibre
Nutricomp Energy Fibre
Nutricomp MCT
Nutricomp Nutricomp Standard Hepa Fibre D
Nutricomp Intensiv
Nutricomp Immun
Nutricomp Peptid Nutricomp MCT
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Enteral Nutrition nutritionally complete

Nutricomp Drink Plus Standard diet high in energy without fibre. Nutricomp Standard Nutricomp Standard Fibre Standard diet without or with 1.5% fibre (special prebiotic composition). Nutricomp Energy Nutricomp Energy Fibre Special diet high in energy and protein without or with fibre (2.0% special prebiotic composition). Characteristics Caloric density: 1 ml = 1.5 kcal High quality protein: 75% milk protein 25% soy protein
Characteristics Caloric density: 1 ml = 1.5 kcal High quality protein: milk protein (70.8%) soy protein (29%)
Characteristics Caloric density: 1 ml = 1 kcal High quality protein: 60% milk protein 40% soy protein
as a combination of Fat rapeseed oil, sunflower oil, MCT and fish oil n Ratio of 3: 6: 9 fatty acids: 1: 3.3: 5.0
n
as a combination of Fat soy oil, rapeseed oil (only Standard Fibre) MCT and fish oil n Ratio of 3: 6: 9 fatty acids: Standard: 1: 5.6: 2.1 Standard Fibre: 1: 3.3: 3.5
n
as a combination of Fat MCT (50%), rapeseed oil and fish oil n Ratio of 3: 6: 9 fatty acids: Energy: 1: 1.2: 2.6 Energy Fibre: 1: 1.2: 2.5
n
Sip feed Composition 1000 ml Total energy Protein Fat Carbohydrates Fibre Nutricomp Drink Plus 1500 60 50 200 0 16: 30: 54: 0 Nutricomp Standard 1000 38 33 138 0 15: 30: 55: 0 500 ml bag (neutral) 200 ml plastic bottle (vanilla, chocolate, strawberry, banana, mixed)
1. May differ from country to country
Tube feed Nutricomp Standard Fibre 1040 38 33 138 15 15: 29: 53: 3 500 ml bag (neutral) Nutricomp Energy 1500 75 50 188 0 20: 30: 50: 0 500 ml bag (neutral) 500 ml glass bottle (neutral) Nutricomp Energy Fibre 1560 75 50 188 20 20: 29: 48: 3 500 ml bag (neutral) 500 ml glass bottle (neutral)
kcal g g g g
Caloric distribution % kcal (Protein : Fat : Carbohydrate : Fibre) Presentations1
500 ml glass bottle 500 ml glass bottle (neutral, vanilla, (neutral) caramel, strawberry)
22
Enteral Nutrition
food for special medical purposes

Nutricomp Standard Fibre D Special diet adapted to nutritional needs of patients with diabetes mellitus with starch and 2.0% fibre (high amount of soluble fibre). Characteristics Caloric density: 1 ml = 1.0 kcal High quality protein: 75% milk protein 25% soy protein Nutricomp MCT Special diet adapted to nutritional needs of patients with impaired lipid digestion. Nutricomp Hepa Special diet adapted to nutritional needs of patients with impaired liver function with low amount of fibre.
Characteristics Caloric density: 1 ml = 1.3 kcal High quality protein: 60% milk protein 40% soy protein
Characteristics Caloric density: 1 ml = 1.3 kcal Specific amino acid pattern: milk protein branched-chain amino acids
from sunflower oil, Fat fish oil and rapeseed oil n Ratio of 3: 6: 9 fatty acids: 1: 2.1: 9.1 n Rich in MUFA (60% of fat energy)
n n
from MCT (60%) and Fat soy oil (40 %) n Ratio of 3: 6: 9 fatty acids: 1: 7: 2.7
n
from MCT (50 %) and Fat soy oil (43%) n Ratio of 3: 6: 9 fatty acids: 1: 7: 3
n
With antioxidants
Tube feed Nutricomp Standard Fibre D 1030 41 35 129 15 16: 31: 49: 4 Nutricomp MCT 1300 56 44 171 0 17: 30: 53: 0 Nutricomp Hepa 1300 40 58 155 5.6 12: 40: 48: 0 Composition 1000 ml Total energy Protein Fat Carbohydrates Fibre
kcal g g g g
% kcal Caloric distribution (Protein : Fat : Carbohydrate : Fibre) Presentations1
500 ml bag (neutral)
500 ml bag (neutral)
500 ml bag (chocolate)
500 ml glass bottle (neutral)
500 ml glass bottle (chocolate)
23
Food for special medical purposes

Nutricomp Intensiv Special diet adapted to nutritional needs of patients with posttraumatic metabolism, respiratory failure. Nutricomp Immun Special diet adapted to nutritional needs of patients with impaired immune functions with fibre. Nutricomp Peptid Special diet adapted to nutritional needs of patients with maldigestion and malabsorption.
Characteristics n Caloric density: 1 ml = 1.3 kcal

n
Characteristics Caloric density: 1 ml = 1.33 kcal
Characteristics Caloric density: 1 ml = 1 kcal
High quality protein: 61% milk protein 39% soy protein
High quality protein: 61% milk protein 38% wheat protein hydrolysate n Special amino acid pattern
n
High quality protein: 45% milk protein 55% soy protein and gelatine n Protein as defined oligopeptides: free amino acids oligopeptides
n
from MCT (51%) and Fat soy oil (47 %) n Ratio of 3: 6: 9 fatty acids: 1: 7: 2.7
n
as a combination of Fat MCT (42 %) rapeseed oil, sunflower oil, fish oil n Ratio of 3: 6: 9 fatty acids: 1: 2.9: 4.4
n n
as a combination of Fat MCT (44 %) and soy oil (47 %), milk fat n Ratio of 3: 6: 9 fatty acids: 1: 6.9: 3.2
n
Rich in glutamine: 30 g per 1.995 kcal (1500 ml) Fortified with antioxidants
Tube feed Composition 1000 ml Total energy Protein Fat Carbohydrates Fibre Nutricomp Intensiv 1300 65 58 130 0 20: 40: 40 : 0 Nutricomp Immun 1360 66.8 37 183.4 13.4 20: 24: 54: 2 Nutricomp Peptid 1000 38 11.2 188 0 14: 12: 74: 0 500 ml bag 500 ml glass bottle (neutral)
1. May differ from country to country
kcal g g g g
Caloric distribution % kcal (Protein : Fat : Carbohydrate : Fibre) Presentations1
500 ml glass bottle
24
Enteral Nutrition
Enteral Nutrition application sets: Enteroport plus and accessories

Enteroport plus Enteral nutrition pump for controlled gastric and intestinal application of tube feeding diets. For inpatient and outpatient use. Pump administration sets
Enteroport plus Set with storage bag (500, 1000, 2500 ml)
Enteroport plus Set FL with connector for crown cork bottles
Enteroport plus Set Multispike for use with bags
Enteroport plus Set Universal Adapter for crown cork and wide neck bottles and bags
Characteristics n Easy to operate and for mobile use n Small size, low weight (450 g) n Operating modes: continuous application, volume / time selection, bolus application n Infusion rate: 1-400 ml/h, bolus volume: 1-1000 ml n Integrated safety functions with acoustic and visual alarms n Memory function n Rechargeable batteries, mains input
Characteristics n DEHP free n Combined cone and female Luer-Lock connector with closure cap n Conformity to DIN EN 1615 n Y-adapter for Luer syringes n Length: 210 cm n Roller clamp and drip chamber
Presentations* Enteroport plus 230 V Supportstand Pole clamp

Art. No. 8710350 8721670 8721061
Presentations* Enteroport plus Set 500 Enteroport plus Set 1000 Enteroport plus Set 2500 Enteroport plus Set FL Enteroport plus Set Multispike Enteroport plus Set Universal Adapter
Art. No. 8721726 8721734 8721742 8721688 8721750 8721744
25
Infusomat Space System The ICU-Solution for Clinical Nutrition

Infusomat Space ideal for clinical nutrition Hospitals equipped with a Space system do not require additional pumps dedicated to nutrition. Not only does this save staff time, because additional user trainings are no more required, it also cuts the cost of maintenance and service.
26
Enteral Nutrition
Infusomat Space Line Type Enteral Nutrition with integrated nutrition bag
Infusomat Space Line Type Enteral Nutrition with universal connector
Ready-to-Use solutions Adapter for most ready-to-use containers n With mix-up proof patient connector n Scaled cone adapter n PVC-free
n
Presentations* Infusomat Space Line Type Enteral Nutrition, with universal connector
Art. No. 8250857SP
Patient Tailored Solution n With integrated 1000 ml nutrition bag n With mix-up proof patient connector n Scaled cone adapter n Needle-free Y-Port with integrated BCV n DEHP-Free
Presentations* Infusomat Space Line Type Enteral Nutrition, with 1000 ml nutrition bag Art. No. 8250839SP
For crown cap of glass bottles. For wide neck (screw cap) of plastic bottles.
User benefits The only enteral line which supports the use of patient tailored EN and safe system compatibility of an "allround pump".
User benefits The only multifunctional enteral line which supports safe system compatibility of an "allround pump".
27
Enteral Nutrition application sets

Nutrifix Gravity administration sets. Enterofix 1000 Bag for fluid application to be used with Multispike connector.
Nutrifix Set with storage bag (1000, 2500 ml)
Nutrifix FL with connector for crown cork bottles
Nutrifix Multispike for use with bags
Nutrifix Universal Adapter for crown cork and wide neck bottles and bags
Characteristics n DEHP free n Combined cone and female Luer-Lock connector with closure cap n Conformity to DIN EN 1615
Characteristics n Storage bag (1000 ml) n Connection with Multispike connector (e.g. Enteroport plus Set Multispike, Nutrifix Multispike)
Presentations* Nutrifix 1000 Nutrifix 2500 Nutrifix FL Nutrifix Multispike Nutrifix Universal Adapter
Art. No. 9240677 9240685 9240669 9240632 9240621
Presentations* Enterofix 1000
Art. No. 9240799
28
Enteral Nutrition
Nasal tubes
Nutritub Polyurethane feeding tubes for long-term naso-gastric and naso-intestinal tube feeding. Gastric and duodenal tubes Naso-gastric and nasointestinal PVC tubes for short term use.
Characteristics n Made of soft polyurethane, flexible, without softeners n Radiopaque stripes, length markings n Funnel connector with integrated syringe adapter, male Luer-Lock connector n Some tubes are equipped with a stylet n Intestinal tubes have weighted ends
Presentations* Nutritub Paed Nutritub Gastral Nutritub Gastral Nutritub Gastral Nutritub Gastral Nutritub Gastral Nutritub Intestinal Nutritub Intestinal LL LL LL/M TR/M TR/M TR TR/M TR/M CH 6 CH 8 CH 8 CH 8 CH 12 CH 15 CH 8 CH 12 60 cm 100 cm 100 cm 100 cm 100 cm 100 cm 120 cm 120 cm Art. No. 9246509 9246517 9246525 9246533 9246541 9246550 9246576 9246584
Characteristics Closed ends n Two or four lateral eyes n Radiopaque stripe n Gastric tube CH 16 equipped with a stylet
n
Presentations* Duodenal tube Duodenal tube Duodenal tube Gastric tube Gastric tube Gastric tube Gastric tube Gastric tube Gastric tube Gastric tube Gastric tube TR TR TR L L L L L L L TR/M CH14 CH16 CH18 CH4.5 CH4.5 CH6 CH9 CH9 CH12 CH12 CH16 122 cm 122 cm 122 cm 38 cm 50 cm 50 cm 50 cm 100 cm 50 cm 100 cm 80 cm
Art. No. 4371143 4371160 4371186 4396049 4396057 4396154 4396251 4396308 4396359 4396405 4372166
* may differ from country to country LL = Luer-Lock; TR = funnel connector; LL/M = Luer-Lock/Mandrin (stylet), TR/M = funnel connector/Mandrin (stylet)
L = Luer, TR = funnel connector, TR/M = funnel connector/Mandrin (stylet)
29
Product Description Parenteral Nutrition

Aminoplasmal B. Braun
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 Aminoplasmal B. Braun 5%E 10% 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 Total amino acids (g) Total Nitrogen (g) Caloric value (kcal) Theoretical osmolarity (mOsmo/L) pH Electrolytes (mmol) Sodium Potassium Magnesium Phosphate Acetate Chloride 5 %E 50 8 200 588 5.7 6.3 50 25 2.5 10 35 45 10% 100 16 400 864 5.7 6.3 10 %E 100 16 400 1,021 5.7 6.3 50 25 2.5 10 46 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. B. Braun Melsungen AG 34209 Melsungen, Germany
Aminoplasmal-15% /15%E
Composition Each 1000 ml contains: 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 Aminoplasmal 15 % 15 %E 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 16.20 3.00 0.50 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 16.20 3.00 0.50 Electrolytes (mmol) Sodium Potassium Magnesium Phosphate Acetate Chloride
15% -
15 %E 50 30 2,6 9,0 35 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. B. Braun Melsungen AG 34209 Melsungen, Germany
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 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 Each 1000 ml contains: 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
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. However, 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. B. Braun Melsungen AG 34209 Melsungen, Germany
Specific Product Information may differ from country to country 30
Glucose Intravenous Infusion

Composition Each 1000 ml solution contains: Glucose 30% 40% 300 400 330 440 300 400 5025/ 6700/ 1200 1600 1665 2220
Glucose As glucose monohydrate Carbohydrate contents Caloric value Theor. Osmolarity
(g) (g) (g) (kJ/ kcal) (mOsm/l)
10% 100 110 100 1675/ 400 555
20 % 200 220 200 3350/ 800 1100
50% 500 550 500 8375/ 2000 2770
70 % 700 770 700 11725/ 2800 3880
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. Subject to sale by pharmacists only. B. Braun Melsungen AG 34209 Melsungen, Germany
Indications: - Energy supply by means of glucose - Carbohydrate component in parenteral nutrition - Therapy of hypoglycaemia
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, -Tocopherol*, Water for injections Caloric Value (kcal): 1022 1908 Theor. osmolarity (mOsmo/L) 345 380 pH: 6.5-8.8 6.5-8.5 * The amount of egg yolk phospholipids and -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. Subject to sale by pharmacists only.
B. Braun Melsungen AG 34209 Melsungen, Germany

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 Special warnings and precautions for use 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. Subject to sale by pharmacists only. B. Braun Melsungen AG 34209 Melsungen, Germany
Nutriflex
Composition Nutriflex (mixed and ready for use 1000 ml) Active ingredients Nutriflex peri (40/80) L-isoleucine 2.34 g L-leucine 3.13 g L-lysine HCl 2.84 g (equivalent to L-lysine) 2.27 g L-methionine 1.96 g L-phenylalanine 3.51 g L-threonine 1.82 g L-tryptophan 0.57 g L-valine 2.60 g Arginine glutamate 4.98 g (equivalent to Arginine 2.70 g and to Glutamic acid) 2.28 g 1.69 g L-histidine HCl H2O (equivalent to Histidine) 1.25 g L-alanine 4.85 g L-aspartic acid 1.50 g L-(+)-glutamic acid 1.22 g Amino acetic acid 1.65 g L-proline 3.40 g L-serine 3.00 g 88.00 g Glucose H2O (equivalent to anhydrous glucose) 80.00 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 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) Electrolytes: + Na K+ Ca++ Mg++ Cl H2PO4 Acetate peri (40/80) 40 5.7 80 2010 (480) 1340 (320) 900 mmol 27.0 15.0 2.5 4.0 31.6 5.7 19.5 basal (32/125) 32 4.6 125 2640 (630) 2090 (500) 1140 mmol 49.9 30.0 3.6 5.7 50.0 12.8 35.0 plus (48/150) 48 6.8 150 3310 (790) 2510 (600) 1400 mmol 37.2 25.0 3.6 5.7 35.5 20.0 22.9 special (70/240) 70 10.0 240 5190 (1240) 4020 (960) 2100 mmol 40.5 25.7 4.1 5.0 49.5 14.7 22.0
basal (32/125) 1.88 g 2.50 g 2.27 g 1.82 g 1.56 g 2.81 g 1.45 g 0.46 g 2.08 g 3.98 g 2.16 g 1.82 g 1.35 g 1.00 g 3.88 g 1.20 g 0.98 g 1.32 g 2.72 g 2.40 g 137.50 g 125.00 g 1.40 g 0.53 g 1.23 g 1.74 g 3.20 g 0.96 g 0.10 g 1000 ml
plus (48/150) 2.82 g 3.76 g 3.41 g 2.73 g 2.35 g 4.21 g 2.18 g 0.68 g 3.12 g 5.98 g 3.24 g 2.74 g 2.03 g 1.50 g 5.82 g 1.80 g 1.47 g 1.98 g 4.08 g 3.60 g 165.00 g 150.00 g 0.53 g 1.23 g 3.12 g 1.56 g 1.40 g 0.23 g 1000 ml
special (70/240) 4.11 g 5.48 g 4.97 g 3.98 g 3.42 g 6.15 g 3.18 g 1.00 g 4.54 g 8.72 g 4.73 g 3.99 g 2.96 g 2.19 g 8.49 g 2.63 g 2.15 g 2.89 g 5.95 g 5.25 g 264.00 g 240.00 g 0.60 g 1.08 g 2.00 g 1.63 g 0.62 g 1.14 g 1000 ml
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. Subject to sale by pharmacists only. B. Braun Melsungen AG 34209 Melsungen, Germany

NuTRIflex Lipid
Composition NuTRIflex Lipid (mixed and ready for use 1250 ml) Active ingredients NuTRIflex Lipid NuTRIflex Lipid NuTRIflex Lipid NuTRIflex Lipid NuTRIflex Lipid peri plus plus without special special without electrolytes electrolytes Isoleucine 2.34 g 2.82 g 2.82 g 4.105 g 4.10 g Leucine 3.13 g 3.76 g 3.76 g 5.48 g 5.48 g Lysinehydrate 3.065 g 4.47 g Lysine 2.73 g 3.98 g Lysine hydro2.84 g 3.41 g 4.975 g chloride Lysine 2.26 g 2.73 g 3.98 g Methionine 1.96 g 2.35 g 2.35 g 3.42 g 3.42 g Phenylalanine 3.51 g 4.21 g 4.21 g 6.145 g 6.145 g Threonine 1.82 g 2.18 g 2.18 g 3.175 g 3.175 g Tryptophan 0.57 g 0.68 g 0.68 g 1.00 g 1.00 g Valine 2.60 g 3.12 g 3.12 g 4.505 g 4.505 g Arginine 2.70 g 3.24 g 3.24 g 4.725 g 4.725 g Histidine 1.69 g 2.03 g 2.96 g hydrochloride monohydrate Histidine 1.25 g 1.50 g 1.50 g 2.19 g 2.19 g Alanine 4.85 g 5.82 g 5.82 g 8.49 g 8.49 g Aspartic acid 1.50 g 1.80 g 1.80 g 2.625 g 2.625 g Glutamic acid 3.50 g 4.21 g 4.21 g 6.135 g 6.135 g Glycine 1.65 g 1.98 g 1.98 g 2.89 g 2.89 g ( aminoacetic acid) Proline 3.40 g 4.08 g 4.08 g 5.95 g 5.95 g Serine 3.00 g 3.60 g 3.60 g 5.25 g 5.25 g Glucose mono88.0 g 165.0 g 165.0 g 198.0 g 198.0 g hydrate Anhydrous 80.0 g 150.0 g 150.0 g 180.0 g 180.0 g glucose Soya bean oil 25.0 g 25.0 g 25.0 g 25.0 g 25.0 g Medium chain 25.0 g 25.0 g 25.0 g 25.0 g 25.0 g triglycerides Indications When oral or enteral feeding is not possible, insufficient or contraindicated. Contraindications Acute shock, acute phase of myocardial and cerebral infarction, severe disorders of blood coagulation, acute thrombo-embolism or fat embolism, irreversible liver damage, intrahepatic cholestasis, severe uraemia when dialysis facilities are not available, disorders of lipid metabolism such as pathological hyperlipaemia and conditions associated with triglyceride accumulation during parenteral nutrition, inborn errors of amino acid metabolism, untreated or complicated diabetes mellitus, especially in the presence of coma related to keto-acidosis or diabetic precoma. These infusions should not be given to neonates and infants up to the age of 24 months. Precautions Should be administered with caution to patients with cardiac or renal dysfunction. Disorders of the fluid, electrolyte, and acid-base balance, e.g., overhydration, hyperkalaemia, acidosis, should be corrected before administration. Too rapid infusion can cause fluid overloading resulting in overhydration, congested states, pulmonary oedema, impaired pulmonary diffusion capacity. Give with caution in conditions of impaired lipid metabolism as in renal insufficiency, diabetes mellitus, pancreatitis, impaired liver function, hypothyroidism (if hypertriglyceridaemic), sepsis and in conditions of altered amino acid metabolism. As with other solutions containing glucose, administration of NuTRIflex Lipid formulations may lead to hyperglycaemia. Blood glucose levels should be monitored and the rate of infusion adjusted or insulin should be administered if hyperglycaemia occurs. The patients capacity to eliminate the infused fat from the circulation should be monitored. Especially where the product is administered for extended periods of time, the patients haemogram, blood coagulation, liver function, and platelet count should be regularly monitored. NuTRIflex Lipid NuTRIflex Lipid NuTRIflex Lipid NuTRIflex Lipid NuTRIflex Lipid peri plus plus without special special without electrolytes electrolytes 1.170 g 2.34 g 3.120 g 0.976 g 0.503 g 0.277 g 3.434 g 0.858 g 0.588 g 6.58 mg 48 g 6.8 g 150 g 50 g 5300/1265 4500/1075 1540 1215 mmol 50 35 4.0 4.0 0.03 45 15 45 48 g 6.8 g 150 g 50 g 5300/1265 4500/1075 1350 1055 1.464 g 0.473 g 0.313 g 4.611 g 1.137 g 0.779 g 8.78 mg 71.8 g 10 g 180 g 50 g 6175/1475 5005/1195 2090 1545 mmol 67 47 5.3 5.3 0.04 60 20 60 71.8 g 10 g 180 g 50 g 6175/1475 5005/1195 1840 1330
Sodium dihydrogen phosphate dihydrateSodium 0.800 g hydroxide Sodium chloride 1.081 g Sodium ace0.544 g tate trihydrate Potassium 2.943 g acetate Magnesium 0.644 g acetate tetrahydrate Calcium chlo0.441 g ride dihydrate Zinc acetate 6.6 mg di-hydrate Total amino acids 40 g Total nitrogen 5.7 g Total glucose 80 g Total lipids 50 g Total energy 4000/955 (KJ/Kcal) Non-Protein 3330/795 energy (KJ/Kcal) Osmolality 920 (mOsm/kg) Osmolarity (theoret.) 840 (mOsm/l) Electrolytes: mmol Sodium 50 Potassium 30 Calcium 3.0 Magnesium 3.0 Zinc 0.03 Chloride 48 Phosphate 7.5 Acetate 40
In patients suspected to have disorders of fat metabolism, fasting lipaemia should be excluded. In the case of fasting hypertriglyceridaemia the administration of fat is contraindicated. Likewise, hypertriglyceridaemia 12 hours after fat infusion indicates disorders of fat metabolism. Fluid, electrolyte, and acid-base balance should be monitored. As with all parenteral solutions administered through a peripheral/central venous catheter, strict aseptic precautions should be taken. Care should be taken to avoid complications of catheterisation including air embolism and venous thrombosis. Undesirable effects Undesirable effects related to the components of NuTRIflex Lipid peri, NuTRIflex Lipid plus, NuTRIflex Lipid plus without electrolytes, NuTRIflex Lipid special and NuTRIflex Lipid special without electrolytes are rare. Those that do occur are usually reversible and subside when therapy is discontinued. Nausea or vomiting may occasionally occur. In the event of a forced infusion an osmotic diuresis might occur as a result of the high osmolality. During infusion in very rare cases the amino acids might cause hyperazotaemia and acidosis. Immediate (acute) reactions related to the lipid are dyspnoea, cyanosis, allergic reactions, hyperlipaemia, hypercoagulability of the blood, nausea, vomiting, headache, flushing, hyperthermia, sweating, chills, sleepiness, chest and back pain. The infusion should be stopped in these cases. The infusion can be resumed after the disappearance of the symptoms and/or the elevated serum triglyceride levels with reduced dose and/or reduced infusion rate. Close monitoring of the patients general condition and his/her plasma triglyceride levels is recommended. Subject to medical prescription. B. Braun Melsungen AG 34209 Melsungen, Germany

Tracutil
0.0789 mg Sodium selenite 5 H2O (equivalent to 0.3 mol of selenium) Sodium fluoride 1.260 mg (equivalent to 30.0 mol of fluoride) Potassium iodide) 0.166 mg (equivalent to 1.0 mol 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: 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 Wilsons 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. B. Braun Melsungen AG 34209 Melsungen, Germany
Composition 1 ampoule of 10 ml contains Active ingredients: 6.958 mg Iron (II) chlorid 4 H2O (equivalent to 35.0 mol of iron) Zinc chloride, anhydrous 6.815 mg (equivalent to 50.0 mol of zinc) 1.979 mg Manganese (II) chloride 4 H2O (equivalent to 10.0 mol of manganese) 2.046 mg Copper (II) chloride 2 H2O (equivalent to 12.0 mol of copper) 0.053 mg Chromium (III) chloride 6 H2O (equivalent to 0.2 mol of chromium) 0.0242 mg Sodium molybdate 2 H2O (equivalent to 0.1 mol of molybdenum)
34
Enteral Nutrition
Product Description Enteral Nutrition

Nutricomp Drink Plus
Nutrition information per Energy Protein (milk and soy) 100 ml 630 kJ 6.0 g 200 ml 1260 kJ 12 g
Nutricomp Standard
Nutrition information per Energy Protein (milk and soy) 100 ml 421 kJ 100 kcal 3.8 g 500 ml 2105 kJ 500 kcal 18.8 g
Nutricomp Standard Fibre

Nutrition information per Energy Protein (milk and soy) 100 ml 437 kJ 104 kcal 3.8 g 500 ml 2185 kJ 520 kcal 18.8 g
Nutricomp Energy
Nutrition information per Energy Protein (casein) 100 ml 632 kJ 150 kcal 7.5 g 500 ml 3160 kJ 750 kcal 38 g
150 kcal 300 kcal
Carbohydrates, of which Carbohydrates, of which

n
13.8 g 0.44 g 0.005 g 3.3 g 0.99 g 0.5 g 1.7 g 0.26 g 0g 84 ml 0,1 g 150 mg 75 mg 20 mg 65 mg 100 mg 1.2 mg 1.2 mg 150 g 13 g 7 g 0.1 mg 0.2 mg 10 g 7 g 90 g 1 g 1.5 mg 7 g 0.2 mg 0.2 mg 0.2 mg 0.3 g 10 mg 1.8 mg 30 g 0.6 mg 5 g 30 mg 0.1 mg
68.8 g 2.2 g 0.025 g 16.7 g 5g 2.5 g 8.5 g 1.3 g 0g 420 ml 0,5 g 750 mg 375 mg 100 mg 325 mg 500 mg 6 mg 6 mg 750 g 65 g 35 g 0.5 mg 1 mg 50 g 35 g 450 g 5 g 7.5 mg 35 g 1 mg 1 mg 1 mg 1.5 g 50 mg 9 mg 150 g 3 mg 25 g 150 mg 0.5 mg
Carbohydrates, of which
n n
13.8 g 1.5 g 0.008 g 3.3 g 0.92 g 0.53 g 1.2 g 0.3 g 1.5 g 83 ml 0,1 g 150 mg 75 mg 20 mg 65 mg 100 mg 1.2 mg 1.2 mg 150 g 13 g 7 g 0.1 mg 0.2 mg 10 g 7 g 90 g 1 g 1.5 mg 7 g 0.2 mg 0.2 mg 0.2 mg 0.3 g 10 mg 1.8 mg 30 g 0.6 mg 5 g 30 mg 0.1 mg
68.8 g 7.3 g 0.04 g 16.7 g 4.6 g 2.7 g 6.1 g 1.5 g 7.5 g 415 ml 0,5 g 750 mg 375 mg 100 mg 325 mg 500 mg 6 mg 6 mg 750 g 65 g 35 g 0.5 mg 1 mg 50 g 35 g 450 g 5 g 7.5 mg 35 g 1 mg 1 mg 1 mg 1.5 g 50 mg 9 mg 150 g 3 mg 25 g 150 mg 0.5 mg
n n
18.8 g 1.9 g 0.02 g 5g 3g 2.6 g 0.6 g 0.4 g 0g 76 ml 0,15 g 225 mg 112.5 mg 30 mg 97.5 mg 150 mg 1.8 mg 2.25 mg 225 g 19.5 g 10.5 g 0.15 mg 0.3 mg 15 g 13.5 g 135 g 1.5 g 4.5 mg 10.5 g 0.3 mg 0.3 mg 0.3 mg 0.45 g 30 mg 2.7 mg 45 g 0.9 mg 7.5 g 45 mg 0.15 mg
94 g 9.5 g 0.1 g 25 g 15 g 13 g 3g 2g 0g 380 ml 0,75 g 1125 mg 562.5 mg 150 mg 487.5 mg 750 mg 9 mg 11.25 mg 1125 g 97.5 g 52.5 g 0.75 mg 1.5 mg 75 g 67.5 g 675 g 7.5 g 22.5 mg 52.5 g 1.5 mg 1.5 mg 1.5 mg 2.25 g 150 mg 13.5 mg 225 g 4.5 mg 37.5 g 225 mg 0.75 mg
20 g 5.3 g 3.8 g 0.15 g 5.0 g 1.2 g 0.75 g 2.2 g 1.6 g 0.36 g <0.1 g 75 ml 0.1 g 170 mg 72 mg 27 mg 60 mg 115 mg 1.7 mg 1.2 mg 170 g 25 g 16 g 0.30 mg 0.58 mg 12 g 8.3 g 147 g 1.8 g 2.0 mg 12 g 0.18 mg 0.22 mg 0.22 mg 0.55 g 18 mg 2.4 mg 73 g 1.1 mg 8.0 g 30 mg
40 g 11 g 7.6 g 0.75 g 10 g 2.4 g 1.5 g 1.9 g 3.2 g 0.72 g 151 ml 0.2 g 340 mg 144 mg 54 mg 120 mg 230 mg 3.3 mg 2.4 mg 340 g 50 g 32 g 0.6 mg 1.2 mg 23 g 17 g 294 g 3.7 g 4.0 mg 24 g 0.36 mg 0.44 mg 0.44 mg 1.1 g 37 mg 4.8 mg 147 g 2.2 mg 16 g 60 mg
n n
sugar Lactose
sugar Lactose
sugar Lactose
sugar of which Lactose saturated fatty acids of which MCT monounsaturated fatty acids polyunsaturated fatty acids of which -3 fatty acids
Fat, of which
n
Fat, of which
n
Fat, of which
n
Fat, of which
n
saturated fatty acids of which MCT
n n
essential fatty acids -3 fatty acids
n n
n n
Fibre Water Sodium Potassium Calcium Magnesium Phosphorus Chloride Iron Zinc Copper Iodine Chromium Fluoride Manganese Molybdenum Selenium Vitamin A (RE) Vitamin D Vitamin E (-TE) Vitamin K Vitamin B1 Vitamin B2 Vitamin B6 Vitamin B12 Vitamin C Niacin (NE) Folic acid Pantothenic acid Biotin Choline Natural mixture of carotenoids Beta-Carotene
Fibre Water Sodium Potassium Calcium Magnesium Phosphorus Chloride Iron Zinc Copper Iodine Chromium Fluoride Manganese Molybdenum Selenium Vitamin A (RE) Vitamin D Vitamin E (-TE) Vitamin K Vitamin B1 Vitamin B2 Vitamin B6 Vitamin B12 Vitamin C Niacin (NE) Folic acid Pantothenic acid Biotin Choline Beta-Carotene
35

Nutricomp Energy Fibre
Nutrition information per Energy Protein (milk and soy) 100 ml 655 kJ 156 kcal 7.5 g 500 ml 3275 kJ 780 kcal 38 g Protein (milk and soy)
Nutricomp Standard Fibre D

Nutrition information per Energy 100 ml 432 kJ 103 kcal 4.1 g 500 ml 2160 kJ 515 kcal 20.5 g
Nutricomp MCT
Nutrition information per Energy Protein (milk and soy) 100 ml 550 kJ 130 kcal 5.6 g 500 ml 2750 kJ 650 kcal 28 g
Nutricomp Hepa
Nutrition information per Energy Protein (milk) of which
n
100 ml 550 kJ 130 kcal 4g 1.8 g 15.5 g 1.6 g 0.05 g 5.8 g 3.5 g 3g 1.6 g 0.6 g 74 ml 0,09 g 156 mg 71.5 mg 26 mg 60 mg 91 mg 1.56 mg 1.56 mg 195 g 16.9 g 9.1 g 0.13 mg 0.26 mg 13 g 9.1 g 117 g 1.3 g 1.95 mg 9.1 g 0.26 mg 0.26 mg 0.26 mg 0.39 g 13 mg 2.34 mg 39 g 0.78 mg 6.5 g 39 mg 0.13 mg
500 ml 2750 kJ 650 kcal 20 g 9g 77.5 g 8g 0.25 g 29 g 17.5 g 14.8 g 8.1 g 2.8 370 ml 0,46 g 780 mg 358 mg 130 mg 299 mg 455 mg 7.8 mg 7.8 mg 975 g 85 g 46 g 0.7 mg 1.3 mg 65 g 46 g 585 g 6.5 g 9.8 mg 46 g 1.3 mg 1.3 mg 1.3 mg 2 g 65 mg 12 mg 195 g 3.9 mg 33 g 195 mg 0.65 mg
branched chain amino acids
n n
18.8 g 1.6 g 0.02 g 5g 3g 2.6 g 0.6 g 0.4 g 2g 75 ml 0,15 g 225 mg 112.5 mg 30 mg 97.5 mg 150 mg 1.8 mg 2.25 mg 225 g 19.5 g 10.5 g 0.15 mg 0.3 mg 15 g 13.5 g 135 g 1.5 g 4.5 mg 10.5 g 0.3 mg 0.3 mg 0.3 mg 0.45 g 30 mg 2.7 mg 45 g 0.9 mg 7.5 g 45 mg 0.15 mg
94 g 8.2 g 0.1 g 25 g 15 g 13 g 3g 2g 10 g 375 ml 0,75 g 1125 mg 562.5 mg 150 mg 487.5 mg 750 mg 9 mg 11.25 mg 1125 g 97.5 g 52.5 g 0.75 mg 1.5 mg 75 g 67.5 g 675 g 7.5 g 22.5 mg 52.5 g 1.5 mg 1.5 mg 1.5 mg 2.25 g 150 mg 13.5 mg 225 g 4.5 mg 37.5 g 225 mg 0.75 mg
n n n
12.9 g 0.5 g 0.007 g 12.3 g 3.5 g 0.6 g 2.2 g 0.5 g 0.2 g 2.0 g 83,4 ml 0,1 g 150 mg 75 mg 20 mg 65 mg 100 mg 1.2 mg 1.2 mg 150 g 13 g 12 g 0.1 mg 0.2 mg 10 g 9 g 90 g 1 g 3 mg 7 g 0.2 mg 0.2 mg 0.2 mg 0.3 g 20 mg 1.8 mg 30 g 0.6 mg 5 g 30 mg 0.24 mg 0.1 mg
64.5 g 2.4 g 0.035 g 61.5 g 17.5 g 3.2 g 11 g 2.5 g 1.1 g 10 g 417 ml 0,5 g 750 mg 375 mg 100 mg 325 mg 500 mg 6 mg 6 mg 750 g 65 g 60 g 0.5 mg 1 mg 50 g 45 g 450 g 5 g 15 mg 35 g 1 mg 1 mg 1 mg 1.5 g 100 mg 9 mg 150 g 3 mg 25 g 150 mg 1.2 mg 0.5 mg
n n
17 g 1.7 g 0.008 g 4.4 g 3g 2.6 g 1g <0.1 g 79 ml 0,13 g 195 mg 97.5 mg 26 mg 84.5 mg 130 mg 1.56 mg 1.56 mg 195 g 17 g 9.1 g 0.13 mg 0.26 mg 13 g 9.1 g 117 g 1.3 g 2 mg 9.1 g 0.26 mg 0.26 mg 0.26 mg 0.39 g 13 mg 2.3 mg 39 g 0.78 mg 6.5 g 39 mg 0.13 mg
86 g 8.5 g 0.04 g 22 g 15 g 13 g 5g
n n
sugar Lactose
sugar Lactose starch saturated fatty acids monounsaturated fatty acids essential fatty acids -3 fatty acids
sugar Lactose
sugar Lactose
Fat, of which
n
Fat, of which
n n
Fat, of which
n
Fat, of which
n
n n
n n
essential fatty acids
Fibre 395 ml 0,65 g 975 mg 488 mg 130 mg 423 mg 650 mg 7.8 mg 7.8 mg 975 g 85 g 46 g 0.65 mg 1.3 mg 65 g 46 g 585 g 6.5 g 9.8 mg 46 g 1.3 mg 1.3 mg 1.3 mg 2 g 65 mg 12 mg 195 g 3.9 mg 33 g 195 mg 0.65 mg Water Sodium Potassium Calcium Magnesium Phosphorus Chloride Iron Zinc Copper Iodine Chromium Fluoride Manganese Molybdenum Selenium Vitamin A (RE) Vitamin D Vitamin E (-TE) Vitamin K Vitamin B1 Vitamin B2 Vitamin B6 Vitamin B12 Vitamin C Niacin (NE) Folic acid Pantothenic acid Biotin Choline Natural mixture of carotenoids Beta-Carotene
36
Enteral Nutrition

Nutricomp Intensiv
Nutrition information per Energy Protein (milk and soy) 100 ml 550 kJ 130 kcal 6.5 g 500 ml 2750 kJ 650 kcal 33 g Protein (wheat protein hydrolysate and milk protein) Carbohydrates, of which
n n
Nutricomp Immun
Nutrition information per Energy 100 ml 572 kJ 500 ml 2860 kJ
Nutricomp Peptid
Nutrition information per Energy Protein (hydrolysate from 100 ml 424 kJ 500 ml 2120 kJ
136 kcal 680 kcal
100 kcal 500 kcal
6.67 g 2.0 g 18.3 g 1.8 g 0.014 g 3.7 g 1.8 g 1.6 g 0.8 g 0.2 g 1.3 g 78 ml 0.13 g 200 mg 99.8 mg 26.6 mg 86.5 mg 133 mg 1.6 mg 2 mg 200 g 17.3 g 9.3 g 0.13 mg 0.27 mg 13.3 g 12 g 120 g 1.3 g 4 mg 9.3 g 0.27 mg 0.27 mg 0.27 mg 0.4 g 26.6 mg 2.4 mg 39.9 g 0.8 mg 6.7 g 40 mg 0.13 mg
33.4 g 10 g 91.7 g 9.2 g 0.07 g 18.5 g 9.2 g 7.9 g 3.9 g 1.1 g 6.7 g 390 ml 0.67 g 998 mg 499 mg 133 mg 432 mg 665 mg 8 mg 10 mg 998 g 86 g 47 g 0.67 mg 1.33 mg 67 g 60 g 599 g 6.7 g 20 mg 47 g 1.3 mg 1.3 mg 1.3 mg 2 g 133 mg 12 mg 200 g 4 mg 33 g 200 mg 0.7 mg
milk, soy, gelatine) Carbohydrates, of which

n
3.8 g 18.8 g 0.9 g 0.35 g 1.1 g 0.7 g 0.57 g 0.37 g
19 g 94 g 4.5 g 1.75 g 5.6 g 3.5 g 2.9 g 1.9 g
13 g 1.3 g 0.009 g 5.8 g 3.5 g 3g 1.7 g <0.1 g 79 ml 0,13 g 195 mg 97.5 mg 26 mg 84.5 mg 130 mg 1.56 mg 1.56 mg 195 g 17 g 9.1 g 0.13 mg 0.26 mg 13 g 9.1 g 117 g 1.3 g 2 mg 9.1 g 0.26 mg 0.26 mg 0.26 mg 0.39 g 13 mg 2.3 mg 39 g 0.78 mg 6.5 g 39 mg 0.13 mg
65 g 6.7 g 0.045 g 29 g 18 g 15 g 8.5 g
of which glutamine sugar Lactose saturated fatty acids of which MCT
sugar Lactose
n
sugar Lactose saturated fatty acids of which MCT
Fat, of which
n
Fat, of which
n
Fat, of which
n
2.8 397 ml 0,65 g 975 mg 488 mg 130 mg 423 mg 650 mg 7.8 mg 7.8 mg 975 g 85 g 46 g 0.65 mg 1.3 mg 65 g 46 g 585 g 6.5 g 9.8 mg 46 g 1.3 mg 1.3 mg 1.3 mg 2 g 65 mg 12 mg 195 g 3.9 mg 33 g 195 mg 0.65 mg
n
<0.1 g 84 ml 0.14 g 120 mg 50 mg 18 mg 40 mg 96 mg 0.9 mg 0.75 mg 100 g 13 g 5 g 0.08 mg 0.15 mg 10 g 5.7 g 50 g 0.5 g 0.6 mg 4.5 g 0.08 mg 0.09 mg 0.1 mg 0.3 g 4.5 mg 1 mg 20 g 0.51 mg 5 g 20 mg
420 ml 0.7 g 600 mg 250 mg 90 mg 200 mg 480 mg 4.5 mg 3.8 mg 500 g 65 g 25 g 0.38 mg 0.8 mg 50 g 29 g 250 g 2.5 g 3 mg 23 g 0.38 mg 0.43 mg 0.5 mg 1.5 g 23 mg 5 mg 100 g 2.6 mg 25 g 100 mg
37
Notes
38
Enteral Nutrition
Notes
39
B. Braun Melsungen AG | Hospital Care | 34209 Melsungen | Germany Tel. +49 5661 71-0 | www.bbraun.com | www.nutrition-partner.com
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Your Nutrition Partner to improve Life

Your nutrition partner to improve life

1060 % malnutrition based on 5.120 patients1

Average length of hospital stay in surgical patients in relation to nutritional support 4

Complication rate in orthopedic patients 5 3

Parenteral and enteral ...

6. Pichard et al. Clin. Nutr. (2000) 19(4); 245-251

... it is all about nutrition

Binding forward-looking technology

Enteral Nutrition Parenteral Nutrition Insulin Pump

Space Control User Interface

with highest treatment quality

1. Blood sampling and analysis

Automatic insulin application

2. Input of glucose value into SpaceControl

3. Conrmation of suggested insulin rate

Automatic calculation of appropriate insulin rate and next sampling time

B. Braun Space GlucoseControl:

Conventional Glucose Control

Strict Glucose Control within a range of 4.46.1 mmol/l (80110 mg/dl) 7

The NuTRIflex system for your convenience

Nutriflex 2-chamber bag

NuTRIflex Lipid 3-chamber bag

Amino Acid Lipid

Latex-free PVC-free DEHP-free

Mix add mix infuse

4. Finally, mix thoroughly before inserting the giving set.

PN regimens for individual fat requirements

Flexibility in adding optional lipid emulsions such as Lipoplus2 or Lipofundin MCT/LCT1

Nutriflex peri 40 5.7 80 + 480 320 1000, 2000

Nutriflex basal 32 4.6 125 + 630 500 1000, 2000

Nutriflex plus 48 6.8 150 + 790 600 1000, 2000

Nutriflex special 70 10.0 240 + 1240 960 1000, 1500

Parenteral Nutrition Clinical

Nutriflex global portfolio overview*

NuTRIflex Lipid peri 40 5.7 80 50 + 955 795 1250, 1875, 2500

NuTRIflex Lipid plus

NuTRIflex Lipid special

48 6.8 150 50 1265 1075 1250, 1875, 2500

71.8 10 180 50 1475 1195 1250, 1875, 2500

NuTRIflex Lipid global portfolio overview*

The single bottle system

for parenteral nutrition

Compounding of a Nutrimix mixing bag

1. Trade name in some countries: Medialipide, Vasolipid

Maintenance of equilibrium of amino acids in blood1 Excellent stability in TPN mixtures2

Composition 1000 ml Amino acids Nitrogen Electrolytes Energy Presentations*

Aminoplasmal B. Braun 5% E g g kcal ml 50 8 + 200 250, 500, 1000

Aminoplasmal B. Braun 10% 10 % E 100 100 16 400 250, 500, 1000 +

Aminoplasmal 15 % 15 % E 150 150 24 600 500, 1000 +

Aminoplasmal Hepa 10 % 100 15.3 400 500

Inflammation-modulating effects - reduced length of hospital stay3, 4 - improves oxygenation index4

1. Trade name in some countries: Medialipide, Vasolipid

Glucose solutions and trace elements

Essential energy source for organs and tissues

Composition 1000 ml Glucose Energy Presentations*

mol/10 ml 35 50 10 12 0.2 0.1 0.3 30 1

Ecoflac plus 500 ml; glass bottle 500 ml/1000 ml

Easy and safe handling

Enteral Nutrition well-being and quality

through complete and balanced nutrition

Sip feed normal digestion and absorption

normal metabolic condition