Quick?? on TPN..

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Specializes in Hospice, Critical Care.

A quick reply if you have a thought would be appreciated...my friend is staring at these bags as I type....

My friend works at nsg home and she is administering TPN and lipids via separate infusions. I've not done this; I've always had lipids & TPN together. The TPN is one bag and the lipids are in a glass bottle. She rec'd tubing for each and one filter. She doesn't know which one gets the filter.

I say filter the TPN and don't filter the lipids. She thought it was the other way around. She doesn't have a pharmacist on hand to ask. What do you think?

(My hospital used to use add-on filters to TPN but doesn't anymore.)

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The TPN gets the filter. You can run them together just plug the lipids in DISTAL to the filter!

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I agree the TPN needs a filter. Usually I see lipids already mixed in TPN. My thought is to piggyback the lipids into the tpn (both on separate pumps) and run both through the single filter, which is on the distal end of the primary tubing. But I guess you can run the lipids separate, if it doesn't need the filter. The NIH website claims that a filter is not needed for lipids alone. Do you have a P&P on hand?

http://www.cc.nih.gov/nursing/tpnsop.html

http://www.utmb.edu/rxhome/Operations/Filtrations.htm

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Specializes in Med/Surg, Geriatrics.

I know it's late but she would definitely need to put the lipids below the filter otherwise they will clog up the filter. Unless you have a .22 micron filter which is large enough to filter lipids.

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Specializes in Hospice, Critical Care.

Thanks for the replies, guys; I appreciate it.

As it turns out, the TPN tubing has an in-line filter. The other filter was indeed for the lipids but it is a MACRO filter, not a microfilter like the TPN uses. (The IV team came in on another case and filled her in on this; the pharmacist hasn't called back yet :)).

I've never administered them separately before either. They were also mixed together.

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

MANY years ago we did them separately. In fact in the 70's and early 80's we didn't even use (or have) PUMPS. That was back in the days when we needed to figure drip rates..... :)

I was VERY happy when "all-in-one" hit the market.

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Specializes in Med-Surg Nursing.

I have worked in two different hospitals in 2 different states and whenever we run TPN, the TPN gets the filter and the Lipids can be piggybacked into the TPN but BELOW the filter on the IV line.

What bothers me at my facility is that most of the patients receiving parenteral nutrition are getting it peripherally. Very rarely do I see PICC's used at this place and I know that the PPn is a killer on the veins. Oh well, when in Rome...

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So, I am new to the Lipids being separate also. The bag of Lipids has directions to give at 64.5cc/hr x 12 hours and the TPN label states to give at 50 cc/hr x 24 hours. The resident has a triple lumen CVC. Do I run them in separate ports?

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Specializes in Infusion Nursing, Home Health Infusion.

If the TPN and lipids are mixed together ( also called a 3 in 1 preparation) then you use a 1.2 micron filter...if you run them separately use the .22 micron in-line or add-on filter for the TPN.....piggyback the Lipids distal to the filter....and yes lipids will eventually occlude the .22 micron filter. You will be able to run it for awhile then when it is saturated with the lipids it will start beeping like crazy. You can also run the Lipids seperately and in that case no filter will be needed. I prefer to piggyback it so I have the other lumen(s) available to me. The purpose of the filter is to capture and trap particulate matter,air and bacteria. The micron size tells you the smallest size particle the filter will retain. So in comparison, a standard blood tubing filter is a 170 micron b/c you need it to only catch bigger matter like blood clots

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Specializes in med/surg.

So, I am new to the Lipids being separate also. The bag of Lipids has directions to give at 64.5cc/hr x 12 hours and the TPN label states to give at 50 cc/hr x 24 hours. The resident has a triple lumen CVC. Do I run them in separate ports?

You can run the TPN and lipids thru the same port. Just use a Y connector and 2 pumps.:)

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The TPN gets the filter. Your lipid tubing attaches below the filter. I used to get this so confused for some reason but finally figured it out by reminding myself that the lipids would totally clog the filter and that would be a big pain.

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Thanks so much for the help. I am grateful that we have this forum to help each other.

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