Clear TPN?

Have you ever given TPN with no MVI in it? I never had until a few nights ago. Just wondering if that's standard at some facilities.

If it's what the patient needs. I'm not a NICU nurse by anymeans but in adults I think that the clear was the norm, with the lips separate and the MVI when needed.

Little more background: On our unit, at least in the time I've been there, TPN has always been yellow, apparently due to the MVI-Pediatric. We do give our lipids separately.

On this shift, when my TPN arrived and I went to double check the contents with the charge nurse, she pulled it out of the bag and said, "This is interesting. It's the wrong color." She's been on our unit for quite a while (>30 yrs) and had never seen it. When she called the doc (a recent addition to our unit from another part of the state), he said, "I didn't order MVI. The baby doesn't need it right now."

The baby was admitted a few hours prior. Because of the doc's reaction, my thought was that some facilities might not include the MVI on DOL 0-1.

Our kids almost always have MVI, unless there's a specific reason. Starter TPN though does not have it.

Then why wouldn't the doc just order a bag of D10 or D12 1/2 ??

There have been a few times where are pharmacy's supply of the MVI for the TPN runs low, and it's on back-order (or something like that). So when that happens, they just order the MVI for every other day - to conserve the supply of it. And yes - it always looks weird when the bags come up! I've never heard of any of our docs not ordering it just because the baby "doesn't need it" - I think it's part of our basic TPN orders...

Then why wouldn't the doc just order a bag of D10 or D12 1/2 ??

That's the thing - we usually hang D10 or D-something on admission (which this kid had), but when it came time to hang the new fluids, the order had all of the stuff we normally associate with TPN (trophamine, cysteine, etc) except for the MVI. I probably should have probed a little bit further with the doc.

as for why not D10 - at least here they want to get the kid on starter TPN asap because they want to get them protein quickly to help their little bodies deal with everything.

This is a very interesting thread. I have been used to having the MVI mixed in the hyperal fluids when working at other hospitals too. I am now working in a hospital where the pharmacy sends up the clear hyperal fluid bag, a syringe filled with the amount of MVI the doctor ordered, and a separate syringe for 20% lipids (hyperal + lipids = total parenteral nutrition).

Interestingly, we hang the hyperal and piggy back the lipids into the hyperal line. Then, we clean a port nearest the baby in the hyperal tubing and inject the MVI in a single squirt. Within about 3 hours all the yellow colored MVI has infused into the patient.

I find this thread interesting because I do not fully understand the reasoning for the way we add the MVI ourselves. I seems there would be less chance of "contamination" if the MVI were mixed with the hyperal fluids under the special (laminar?) hood in the pharmacy as compared with us doing it on the unit...

I am glad this thread appeared; I plan to ask for the reason why we do it the way I described. If I get an answer, I will post it. Until then, if anyone has an idea of why our doctors want the MVI given this way, would you please share it here? I'm very curious.

In adults, we only use MVI once a day, so sometimes the bags are clear, sometimes not.

Our first day TPN does not have MVI in it, therefore it is not yellow, but it does contain all the other nutrients, especially proteins, this is not a special order bag from the pharmacy, but rather one that is standard. We don't typically draw nutrition labs until after 24 hours, then the doc writes the TPN order for exactly what the baby needs. We have had a few periods when the pharmacy was out of MVI and our bags would come up clear....it's really weird getting report and looking up at what should be a banana bag, but it's clear!

Jamie