Hi PICU nurses,
I have a question regarding practice in your unit about intralipid infusions (20% fat emulsion). Do you run them independently of the PN (if PN is also on board)? Do you run them via central access if possible? Most importantly, do you infuse them with your drips (inotropes or otherwise)? Specifically, with milrinone. I am working on changing practice on my unit, and possibly coming up with a lipid initation guideline. It would be SO convenient if I could tell everyone to run them with drips, but it seems that milrinone is the only inotrope that is documented as being incompatible. Practice trumps compatibility suggestion, though, and just wanted to see what other places are doing.
We run our lipids through PIVs most of the time, but it seems like it's pretty harsh on those little veins. Our unit is 100% cardiac, so just about everyone is on milrinone
Thanks in advance for the feedback!
The terminology needs to be a bit more exact when you area talking about this....when you say, "run with " are you talking about mixing in the same lumen of a VAD or a separate lumen?
1. Anything greater than 10 % Dextrose in a nutrition solution must be given in a central vein. It is the percent of dextrose that determines whether or not it must be given centrally.
2 You can piggyback lipids into TPN or PPN distal to the filter if it is a 2.2 micron filter. Any Lipids will eventually clog or occlude this size filter..... it will run for a bit until the filter get saturated and then your pump will start alarming.
3 In the event you have a 3 in 1 solution ( TPN and lipds in one large bag) you must use a 1.2 micron filter. The Lipids can pass through that size.
4. If you cannot have a dedicated line for TPN and/or Lipids then you must have a dedicated lumen. So if you have a triple lumen VAD dedicate one lumen to the nutrition and use the other(s) for anything else. You should not piggyback anything else or give any push meds through that TPN dedicated lumen and avoid using that lumen for blood draws.
5 Lipids can be given peripherally if need be because they have a close enough osmolarity to blood. ( Blood is about 280)
6 All of this important because if is done other ways the risk for infection is much greater. The Lipids are of particular concern because they can have rapid bacterial growth if contaminated...they have the nutrition cells like. You have to be cautions as well with any fat based drugs and that is why the tubing of those drugs are changed more frequently some even every 12 hrs. Also the risk for incompatibility is high especially when there are electrolytes such as calcium in the TPN.
So the standard of care here...Run the TPN and lipids either together as stated with no other drips or Lipids can be given in a peripheral vein with no other drips or meds added to it.
Last edit by iluvivt on Nov 28, '12
Jan 1, '13
by NRSKarenRN, BSN, RN Moderator
Please take advantage of PHARMACIST discussion regarding medication and infusion compatibilities. They are a tremendous resource often overlooked and should be go-to person to help devise a policy regarding Lipid infusions.
Last edit by NRSKarenRN on Mar 27, '13
: Reason: spelling oops