Intralipid (20%) infusion administration

[harryalexx]

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!

[NRSKarenRN, BSN, RN]

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.

[steelRN17]

I work in a pediatric CICU at a major Children's Hospital. We run our TPN/IL together via a Y-site. Anything >12.5% Dextrose must run through a central line. We Y several medications into TPN/IL.. Some I can think off the top of my head are PGE, Milrinone, Lasix (never with milrinone though), Potassium Boluses, Octreotide, certain intermittent antibiotics. I know there are several others that may be compatible as well but dependent on the dextrose concentration. We have a dedicated pharmacist for our unit and does give us permission to run some of those combinations together. Hope this helps and good luck!

[newFNP2015]

I work in a CVICU at a children's hospital as well. We often use tpn as the major line in a manifold with milrinone, sedation, vasoactive, etc running through the manifold. We then put intralipids through a y site as close to the patient as possible. This, of course, is for our kids with central access. We recently started bolusing sedation from pumps which needs a dedicated lumen or piv. In our unit, lasix is always a dedicated line with a saline carrier if needed. Lasix has been on back order though so we have been using bumex which has a slightly better compatibility.

[harryalexx]

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.

Thanks so much for the reference...I wasn't even aware of this resource! I'll check in over there as well.

Since initially posting this, I took this problem (with a couple other nurses) to a higher administrative council within the hospital. Basically, it came down to the fact that our unit uses too many infusions of milrinone to have our IL 20% in-line (Y-site) with MIVF + drips. C'est la vie.

Thanks for everyone's input and practice experience. Much appreciated :)