The 2016 INS standards and the March 2016 Nurse Advise ERR from ISMP state that lipids should be filtered with the 1.2 micron filter.
I am interested to know how facilities write a procedure when TPN comes in 2 seperate bags as it does in our facility. We have one bag of dextrose and amino acids - filter recommendation is 0.22 micron filter and a separate bag of lipids - filter recommendation is 1.2micron filter. Both of these filters are add ons to the IV tubing.
Thank you,
Celia
First of all, following standards, the filters SHOULD NOT BE ADD-ONs.... But rather they should be an integral part of the IV administration set. Add-ons can introduce bacteria as it increases manipulation.
I personally would speak to the IV pharmacist and ask them to make a 3-in-1 solution. Have them mix it all under the laminar flow hood and stop the insanity! LOL. But, if that isn't feasible, then piggyback the lipids into the mainline. Because this will mix with the amino acids/dextrose solution, use a 1.2 micron filter close to the IV site
That method will allow a lot of particulate matter to reach the lungs. For 3-in-1 TNA, the 1.2 micron filter is needed to allow the larger molecule of the IVFE to infuse and prevent some particulate matter to be trapped. I would use a set with a 0.22 micron filter on the protein/carb solution, and a set with 1.2 micron filter on the IVFE. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
But I am confused... IF the situation was that they are connecting the lipids into a Y set on the mainline of the Dextrose/amino bag, Shouldn't they put the 1.2 micron filter below where they intersect?
I emailed the pharmacists at ISMP and got a few answers. The instructions for use for all IVFE products have recently changed to require filtration with a 1.2 micron filter for all infusion methods. The reason is to prevent infusion of a far embolus if the emulsion should crack, which has always been the concern for 3-in-1 PN solutions. Apparently it is now a concern regardless of whether it is admixed in the PN solution or given as a separate infusion.
There are several options for configuring the filters. In my professional opinion, I continue to think that a 0.22 micron filter is needed for the 2-in1 PN infusion due to particulates from the compounding process and bacteria that could enter the system. A 0.22 micron filter will remove these foreign substances. I would then put a 1.2 micron filter on the IVFE and piggyback it below the 0.22 filter.
The other option would be to use a 1.2 micron filter in the system and infuse both PN and IVFE thru the same filter. This would be virtually the same as infusing a 3-in-1 PN solution thru a 1.2 micron filter.
I would want to know what filtration, if any, was done by my pharmacy during the compounding process and then make my clinical decision. If pharmacy is filtering during, then a 1.2 would be sufficient to remove particulate matter. But I would stricly enforce the policy of NOTHINg being injected or piggybacked into this system and the system would ONLY be taken apart when it is time to change the entire sets once per day to reduce bacterial contamination. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Great information. Thank you!