Vancomycin & lipids

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Specializes in NICU.

I work in a hospital where Vancomycin and IntraLipids are NOT compatible thus unless I have a double lumen access line I have to stop my lipid infusion for a little over an hour to infuse my vanc, flush and then restart the lipids.

The hospital where I interned hung vanc with IL all the time!

How is it in your unit?

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Specializes in NICU.

We hang vanc with lipids all the time. We actually even keep TPN running while we give amp, which you're really not supposed to. If it's a big kid who can stand to have the amp given quickly, I'll usually turn off the TPN, though.

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Specializes in NICU.

I've never heard of Amp not being compatible with TPN. We give amp slow IV push. (draw up, dilute, slow push)....

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Specializes in NICU.

According to our kardex - vanc is compatable with lipids. Also according to our kardex - amp is not compatable with TPN. We will stop the TPN, flush the line, give the amp (over 15min), flush the line, and then restart the TPN. It's always nice when the baby has a double lumen and we don't have to worry about that.

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Specializes in NICU.

We don't use ANY multi-lumen lines on our floor. It's so frustrating. Once in a blue moon we'll get a transfer in, or maybe anesthesia or cardiology will put one in during a procedure, but I've had... maybe three? In a year and a half.

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Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.

Vanc used to be incompatible with lipids in our med books, but in the past year it has listed them as compatible.

Amp can be given at a rate of 100mg per minute, so I just turn off my TPN and push it or run it on a pump at the appropriate rate and then start my TPN back up.

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We give our vanc with lipids all the time, unless you have a double lumen and then we put it through there.

Amp is definitely not compatible with TPN, it causes a precipitate that can actually clot off a line, even if it's pushed. We had a kiddo recently who was really sick, on hifi and ino, terrible stick, had finally gotten a picc, but only a single lumen....amp was given through the line and it clotted off within 10 minutes! Thankfully the NNP's were able to overthread it and we still had a line.

Jamie

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Specializes in NICU, PICU, PACU.

Vanco goes without lipids, we just put them on hold. We don't have multi lumens unless it is a UV.

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Specializes in Level II & III NICU, Mother-Baby Unit.

Our sources say that vanc is compatible with hyperal & lipids (together they are TPN) and that ampicillin is much more stable in sterile water and normal saline than in dextrose solutions. Therefore, it is best to not reconstitute Ampicillin in dextrose solutions and when administering ampicillin to stop the TPN, flush the tubing with normal saline, give the medication over 5-15 minutes, flush again with normal saline and then restart the TPN. I personally do this when the baby has plain D10W infusing. I'm not sure if the main culprit is the dextrose in the D10W/hyperal or if the lipids are culprits too... Does anyone know?

Thanks

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Specializes in NICU.

It's the TPN. Neofax lists Dex/AA solutions separately from fat emulsions. Actually... I have one right in front of me. Let's look! I think it must be the protein in the TPN, because Ampcillin is compatible with D5 and D10 and also lipids. So it must be the amino acids.

BTW, in places that don't mix the IL with the Dex/AA solution, we still call it TPN. We keep it separate so that we can cut the IL if the blood sugars go up.

And as to the original question, Neofax claims Vanc is compatible with lipids.

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Specializes in Level III NICU.

We run ours separately as well. We still refer to it as TPN.

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