IV medication filtering

gtmoore · Jul 20, 2009

I believe I came up with a couple more:

Insulin

Propofol

vivacious1healer · Jul 21, 2009

Dilantin

CrufflerJJ, BSN, RN, EMT-P · Jul 21, 2009

Dilantin

The OP's question was re: IV meds that you do NOT filter. Dilantin require filtration.

gtmoore · Jul 21, 2009

Thanks for everyones input.

cardiacRN2006, ADN, RN · Jul 21, 2009

I believe I came up with a couple more:
Insulin

I don't put a filter on insulin gtts, but insulin is added to our TPN, which does require a filter.

So, I'm curious as the the insuln that you mention never using a filter...

The lipids, however, should not be filtered.

Tait, MSN, RN · Jul 21, 2009

I don't put a filter on insulin gtts, but insulin is added to our TPN, which does require a filter.
So, I'm curious as the the insuln that you mention never using a filter...
The lipids, however, should not be filtered.

I don't think the insulin has anything to do with the filtering of TPN. I always assumed it was sort of a bubble trap because TPN always seems to have so much microbubbles in it.

I am sure there is a more relevant reason, but I have never chased the answer!

Tait

cardiacRN2006, ADN, RN · Jul 21, 2009

I didn't say insulin was the cause of filtering TPN. TPN is filtered whether it has insulin or not.

The OP says that insulin should NEVER be filtered. I'm saying, it is filtered all the time when it's included in TPN.

I just would like to know why insulin should never be filtered, since the OP included in their list.

IVRUS, BSN, RN · Jul 22, 2009

"The lipids, however, should not be filtered."

Lipids need filtering!

When giving a 3-1 TPN (one that contains the three main ingredients of TPN - Dextrose, Amino acids and Lipids)

a 1.2 micron filter is needed.

And.. When giving Lipids by themselves, a 1.2 micron filter is needed.

TPN without Lipids should infuse via .22 micron filter.

There is sufficient evidence of particulate matter in IV solutions, that many times we should be filtering when we don't!

vivacious1healer · Jul 22, 2009

The OP's question was re: IV meds that you do NOT filter. Dilantin require filtration.

OOOOOOPPPPSSS!!!!

cardiacRN2006, ADN, RN · Jul 22, 2009

"The lipids, however, should not be filtered."
Lipids need filtering!
When giving a 3-1 TPN (one that contains the three main ingredients of TPN - Dextrose, Amino acids and Lipids)
a 1.2 micron filter is needed.
And.. When giving Lipids by themselves, a 1.2 micron filter is needed.
TPN without Lipids should infuse via .22 micron filter.
There is sufficient evidence of particulate matter in IV solutions, that many times we should be filtering when we don't!

We absolutely DO NOT filter lipids. They are a separate infusion and not included with the TPN and they go below the filter.

I've never seen lipids filtered!

IVRUS, BSN, RN · Jul 23, 2009

Just because one has never seen it done that way, doesn't mean that it shouldn't occur!

Our pharmacy filters Lipids ALL THE TIME!

Whether they are in a 3-in-one, or by themselves. If you'd like to 'PM" me with your fax number, I'd be more than happy to send you the recommended medications that need filtering.

Knowledge is power... Refusing to accept recommendations by leading organizations just because "we don't do it that way" is no excuse for not seeking and doing the "best practice" for your pt.

ASPEN (American Society for Parenteral & Enteral Nutrition) has published practice guidelines for "Safe Practices for Parenteral Nutrition Formulations", which recommends "use of an in-line filter with PN can prevent the administration of particulate matter, air, and microorganisms to patients.. A 0.2 micron filter should be used for 2-in-1 formulations. A 1.2- 5 micron should be used for TNAs (3-in-1 systems). Alternatively, a 1.2 micron filter may be used for all PN formulations.

As for administering PN without a filter, the guidelines indicate "A filter that clogs during administration of PN is indicative of a problem and may be replaced but should never be removed entirely."