Vented tubing for lipids?

[KaeliF]

Hi, I am a new nurse and I got called off tonight so I'm sitting up, reading over some of the skills I haven't done yet so I can be ready when they come up! I've never administer lipid emulsion before, and I found it says that you must use "vented tubing" for this. What exactly does that mean? Do you just pop the vent open on the normal tubing, like you would for hanging a med in a glass bottle, or is there a specific type of tubing I need? Looked all over the internet and books and can't find an answer!

[Hay, RN]

When I worked night shift I hung quite a few lipids. Lipids usually comes in a smaller bag and I did not use 'vented tubing.' You do have to use a filter, though. Maybe the book has a typo and meant 'filtered' and not 'vented' ?

[gizzy123]

You will do not need a filter for lipids they are to be hung with regular tubing attached below the filter hanging them above the filter will ruin both the filter and the lipids. I would check your protocol but we always hand tpn with a filter and the lipids below the filter on the tpn line

[RoyalPrince]

No vented tubing, lipids hang BELOW the filter when TPN is simultaneously infusing

[BluegrassRN]

If lipids come in a glass container, you need a vented tubing; and yes, you just pop the vent on the regular tubing (at least, where I work we do not have separate tubings for vented and unvented infusions). If they come in a bag, you do not.

[turnforthenurse, MSN, NP]

Where I work the tubing that we have acts as both vented and non-vented. If we needed to vent the tubing (if the medication or lipids come in a glass bottle) we just pop open this little white part by the spike. Our lipids come in bags, though, not glass. You don't need vented tubing for that. Pharmacy usually sends up tubing with TPN and lipids. Lipids always go below the filter.

[Fiona59]

I haven't seen lipids in glass bottles since 2001!

[corky1272RN]

Some facilities do use filters for lipids but not all. I used to work at an LTAC that used a bigger filter for the lipids (the TPN had it's own

filter seperately), but at the hospital that I work at now, the lipids are not filtered. Maybe it is their protocol, maybe a different type or brand, not sure if the LTAC even does it anymore. My current hospital started using the bags of fat emulsions about a year or 2 ago, the bags are better.

[iluvivt, BSN, RN]

You will always need a vented tubing if you have any IV medication that comes in a glass bottle. Since glass cannot collapse like a plastic IV bag you need an air source (the vent) otherwise a vacuum will be created. Here is what will happen if you do not have a vent on a glass IV bottle.....it will run for awhile then the drip chamber and the tubing will collapse in on itself and then no longer run..so if you ever see that you know you need a vent.

Now for TPN you will generally see a .22 micron filter used at the most distal part of the tubing. This filter will be air-eliminating and bacterial/particulate retentive. if you are hanging lipids as a seperate bag or bottle...they MUST not be filtered with this size filter...it will eventually block the filter and the infusion will STOP and alarm downstream occlusion. so piggback them in below the filter so they are not passing through it. If the lipids are mistakenly attached above the filter it will run for awhile as well until the filter becomes clogged with the lipids.

You can use a 1.2 micron filter on lipids and that size will not occlude the filter though this is rarely done.

If you are using a 3 in 1 type TPN/lipids (they are all mixed in a very large bag) a 1.2 micron filter will then be used as a distal add on filter.

[canned_bread]

Why are we venting the lipids? Is there a special quality that lipids require it? As above, you need the vent for a glass bottle as it won't drip, but is there another reason? I just googled and couldn't find an answer.

[BluegrassRN]

Why are we venting the lipids? Is there a special quality that lipids require it? As above, you need the vent for a glass bottle as it won't drip, but is there another reason? I just googled and couldn't find an answer.

They would be vented if they came in a glass bottle, unvented if in a bag. It's the container, not the lipids themselves (see several previous posts).

[IVRUS, BSN, RN]

Yes, as ILUVIVT said... If the lipids are coming in a bottle, then you needed vented IV tubing in order for the infusion flow to work properly. Lipids, or a 3 in 1 TPN (TPN with the three main ingredients in it: Dextrose, Amino-acids and Lipids) should be infused with a 1.2 micron filter. However, It should not be an add-on filter, but instead, this filter should be a permenant part of the tubing. Add-ons are not appropriate as each add-on creates a greater possibility of bacterial introduction.