TPN HELP!!! (please)

[peachpower]

So, quickly, a history of what has brought this topic about-

I'm in clinicals, and I made the egregious misake of asking my instructor this question:

"WHY DO THEY HANG LIPIDS SEPARATELY FROM ELECTROLYTES IN TPN??"

I was told to look it up, found no satisfactory answer and had nothing to present in post-conference. Due to that bit of insubordination (???), I now have a 2 page paper due TOMORROW, and have yet to nail a black and white answer. I will truly appreciate any help I can get. I am terrified that I will not have this done.... Please share any and all information that you guys have.

[miss81, BSN, RN]

Also, not too long ago lipids used to be in a GLASS BOTTLE, bought "as is" by the hospital pharmacy and did not need to be altered in any way. TPN is a big BAG of dextrose that the pharmacy adds substances to. Our tubing is a Y set with a shared filter but the side that the Lipids are spiked has a vent for the glass bottle. Of course lipids are mostly in bags or plastic bottles now but still a reason that they were hung separately.

Another point to bring up is the fact that the dietitian and/or doctor makes changes to the rates of the lipids and TPN separately according to blood work and pt response. Having them separate allows you to adjust the rate of each.

These are more just "side" points to bring up. The posters above and the pharm. definitely got it right!

Good luck on the paper!

[kanzi monkey]

Huh, I've only ever hung TPN in one bag (only worked at one institution).

And yeah, your teacher had no idea :)

Another vote for "ask the pharmacist"

Good luck!

[miss81, BSN, RN]

Huh, I've only ever hung TPN in one bag (only worked at one institution).

And yeah, your teacher had no idea :)

Another vote for "ask the pharmacist"

Good luck!

Hey Kanzi Monkey...

Do you mean the lipids were mixed in the same bag as the TPN? Just curious, cause I have never seen it that way.

[flygirl43]

After grad I worked in a large teaching facility that used all in one preps. When I went to work a smaller rural facility they hung lipds and AA seperately, I queried this one with pharmacy. They told me they hung the 2 seperately to be able to screen any contaminants in the AA. I think it was because they were 20 yrs behind the times!

[Reno1978, BSN, RN]

Hey Kanzi Monkey...

Do you mean the lipids were mixed in the same bag as the TPN? Just curious, cause I have never seen it that way.

This is the way that TPN was prepared at the last hospital I worked at...it was all just 1 big bag. Now where I work, the lipid emulsion is in a separate bag. Just depends on the facility, I guess.

Re: the filter - when lipids were included in the mix, we did use a 1.2 micron filter.

[spongebob6286, BSN, RN]

I don't think that is correct. When I hung TPN preparations that included lipids in the solution, we used an in-line filter and they made their merry way to the patient.

we do used filter too on tpn with lipids

[Reno1978, BSN, RN]

They told me they hung the 2 seperately to be able to screen any contaminants in the AA. I think it was because they were 20 yrs behind the times!

That's how I feel - I used to work at a large, 800 bed regional center that used all in one solutions and now I work at a much smaller community hospital since I moved back to my hometown. I feel like it's a step backwards to separate them when I'm used to hanging one bag, one set of tubing, one IV pump through one lumen in the central line....

[morte, LPN, LVN]

TPN with lipids is run with the larger filter. i would think the rationale that it is cost prohibitive to stock a large selection may be the basis of not mixing them that you see in smaller institutions. though i have seen bags with dividers, the lipids on one side and the glucose solution on the other with ports to modify the glucose solution with desired additives....but this doesnt allow for cusomized amounts of lipids.....

[kanzi monkey]

Hey Kanzi Monkey...

Do you mean the lipids were mixed in the same bag as the TPN? Just curious, cause I have never seen it that way.

yup. one big, milky-white bag.

[IVRUS, BSN, RN]

TPN is given with, or without lipids. When it is given with Lipids, it is called a 3 in 1 mixture. That is because it contains your 3 main ingredients: Dextrose, Lipids, and Amino acids. Sometimes a pt won't need the extra fat (which is what lipids are) and the MD may order them to be given 2-3x a week. Therefore your bag will not look like a "Big bag of Milk" but rather clear, or with a slight yellow tinge from the multivitamins. 99.9% of the time, our pharmacy makes and sends 3in1 solutions. With proper admixing, it has stability. A 3-1 TPN needs to be infused via 1.2 micron filter. Lipids by themselves need to infuse via 1.2 micron filter. TPN without Lipids should infuse via .2 micron filter.

[silver1]

Also if your patient is on a propofol gtt, you'll want to make sure your not giving them too much lipids. If its already premixed in the TPN(3in1), your gonna need a new back of TPN, minus the lipids.

[Indy, LPN, LVN]

Ok that's a good point about the propofol. But it brings up a question: Why does propofol tubing have to be changed every 12 hours, period, to avoid infection d/t lipid content, when I see lipid bags hanging for 20 to 24 hours? What makes the lipids for nutrition less susceptible to infection? Are they less susceptible after all, should the bags be 12 hours worth instead of 24, or should we instead be leaving diprivan tubing up for 24 hours instead of 12?