I would love to hear from those RN's, and unit managers where they are administrating undiluted Lipids with a filter. I would like to know what pore size filter are you using and and have you run into any problems. I would also like to get a census of what most think is the correct practice in administering undiluted lipids (not 3 in 1).
We do not use 3 in 1 solution. We run our TPN and Lipids on 1 pump (plum A+). TPN is the primary infusion, and lipids run as a concurrent secondary set. We use a 1.2 micron final filter between the infusion set and the line. We used to use a 0.2 micron filter for the tpn and run a second pump for lipids and connect after the filter. I think the change occured when TPN solutions became available ready made in standard concentrations. The only reason to use the 0.2 filter is for microrganism prevention, but contamination is so rare these days it is not seen as a risk that is any higher than other dextrose solutions. I'm sure there is evidence to support the practice.
Microorganisms are not the only reason to use a 0.22 micron filter for PN. The other very important reason is particulate matter. The fat emulsion molecule is too large to move through the 0.22 micron filter and therefore if filtration is to be done, you must use a 1.2 micron filter. This size filter came into use when 3-in-1 admixture became possible. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861