IV medication filtering

I believe I came up with a couple more:

Insulin

Propofol

Dilantin

Dilantin

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

Thanks for everyones input.

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.

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

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.

"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!

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

OOOOOOPPPPSSS!!!!

"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!

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."

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.

Sorry I missed her second post about the insulin. Now I get it.

:imbar

Tait

In response to the lipid conversation:

https://allnurses.com/nicu-nursing-forum/filter-not-filter-236371.html

I really think it is just a matter of where you work, and your own protocol. Seems the general consensus is not to filter them, and I can not find anything concrete at the moment stating why you should or should not filter them.

Currently attempting to access the above posters information from ASPEN, but the session to register is going very slow.

Here is a bit from drugs.com about Intralipid 20% which we use in our hospital:

Filters of less than 1.2 micron pore size must not be used with admixtures containing Intralipid® 20%.

http://www.drugs.com/pro/intralipid.html

Now from the Merck site on TPN:

In-line filters have not been shown to decrease complications.

http://www.merck.com/mmpe/sec01/ch003/ch003c.html

My conclusion?

Hospitals view filtering TPN to be important. A lot of hospitals most likely use a filter too small for lipids. Hence, we don't filter the lipids.

Some are like this some are not, but that is about all I can ascertain.

Peace :)