Clear TPN?

[EricJRN]

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.

[SteveNNP, MSN, NP]

The one time I've seen clear custom TPN is when the pharmacy's TPN compounder ran out of MVI. The label said it was in it, but it was only after I called and questioned it, they discovered that the machine was empty. Every TPN I've hung (except for our premixed stock micropreemie, large preemie and general TPN) has MVI in it, and is yellow. The stock stuff we keep on hand for new admits is clear.

[prmenrs, RN]

For the 1st day infusions, we used a maintanence IV of D10 or D 5 if they were really little; they got separate infusions of the Trophamine (protein) and vitamins. If they needed the Dextrose changed, we didn't have to the Hyperal re-done. Save $$$$.

[BittyBabyGrower, MSN, RN]

Our starter TPN, which we give to kids under 1500gms on day 0-1 of life has no MVI. It is for the proteins.

I've never heard of not mixing the MVI in the bag when it is made.

[preemieRNkate, RN]

We use what we call "vanilla TPN" for kids less than 1500 grams upon admission and run it until a custom bag of TPN with MVI is ordered. It's a pre-made bag of D7.5 0/0/2/2/0. We then will add a swingline of D10 or D5 if the baby is hypo- or hyperglycemic.

[travelingkind]

We hang clear TPN on fairly new,

Love_2_Learn - I find it strange that you mix the MVI in the unit. Seems like you are right and it would/could lead to contamination/med errors/etc.

[elizabells, BSN, RN]

We use clear stock TPN for the first day - General, Cardiac, Micropreemie and Large Preemie - and that is clear. I've never seen clear TPN other than that. Occasionally we'll hang D10 with Ca Gluc on the cardiacs for the first few hours or plain D10 if we're out of stock TPN on the floor and the pharmacy is busy.

[Love_2_Learn]

OK, so I asked a nurse who has worked in our NICU a very long time why it is that instead of the pharmacy putting the MVI in the bag at the time the hyperal fluids are mixed, that we nurses receive the syringe with the ordered amount of MVI along with the hyperal and lipids and then we instill the MVI in the closest port of the hyperal tubing to the baby; the MVI instills as the fluids infuse and is usually completely in the baby by 3 to 4 hours time. So here is what she said: "It's because we increase and decrease the infusion rate sometimes during the day and night so our neonatologists decided that in order to be sure the baby receives the full amount of MVI ordered that we give it in the line when we hang each new daily bag of hyperal fluids.". Again, I have never seen this done or heard of it being done anywhere but this hospital. Have any of you ever heard of it?

Thanks

[spacey]

HI.......

We also use "vanilla TPN"....sometimes with and sometimes without seperate lipids. It is kept on the unit and comes in a D5 or D10 base.

[JazzyRN]

yeah ive given clear tpn to a pt on a heparin gtt for some rare clotting disorder. they didnt want the MVI because of the vit K interference with the clotting factors

[cc_nurse]

When we admit a micropremie or otherwise critical kid, we always use "Stock TPN" which sounds like what you are describing. Its only used for that first 24 hr period at which point the TPN /c MVI is ordered in the baby specific formulation. Otherwise our more stable admits get D10 as a rule of thumb...