Quote from TiffyRN
I'm not sure why TPN and lipids are always separate but I'm pretty sure it's not because lipids can't be filtered. TPN and lipids are routinely mixed in the same bag in the adult world. There is a special filter that is used just for the TPN mixture (sometimes called 3 in 1 mixture for amino acids, dextrose and lipids).
I thought they were separate to make it easier to give IV meds because so many more meds are compatible with the amino acid/dextrose mixture and aren't compatible with the lipids. Some cancer patients that only have a single lumen PICC get their lipids bolused over 4hrs so other IV meds can be given in the same line as their TPN the rest of the day.
Another reason they're separate in the NICU is because babies can only get so much lipids per day or their triglycerides will be all over the place. However, most of us use the hyperal as the maintenance fluids for the baby, and if fluid volume needs change, this is the IV that we increase or cut back on. If the lipids were mixed in, we'd be screwing up how much lipids the baby gets per day by changing the rate around.
The only time I've seen them mixed together was in home care. The babies who go home with Broviacs and TPN have these IV bags and tubing that have NO AIR in them, so either there is no filter for bubbles or if there is a filter, it's okay for lipids, I forget because it's been a couple of years since I've worked with one of these set-ups. The bag is kind of cool - it is a huge flat IV bag that has hyperal on one side and lipids on the other, separated by a plastic clip. Each day, the mom takes a new bag out of the fridge and pulls the plastic clip off, and then the hyperal and lipids mix together. She primes new tubing and runs it through a small IV pump, the puts the pump and bag into a small backpack, with just the tubing running to the baby. It's smaller than the apnea monitors, even!