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Wed, 08/22/2007 - 09:45

maureen lawler

Final Filters/TPN and Lipids

To filter or not to filter???Â

Liposyn II insert reads/ " 1.2 micron filterÂ CAN Â be used can be used forÂ 3 in one or fat emulsion alone".

INS Standard 32Â / " For TPN and lipid THAT REQUIREÂ filtration a 1.2 micron filter shall be used" .

Perry and Potter/ "IV filter optional" page 1057

JPEN Vol 13, Issue 6, 641-643/Â "TPN and Lipids...trapped on the filter... may block the catheter during long term therapy, suggests the importance of filtering..."

JPEN Vol 20, Issue4, 296-301/ "FDA Safety Alert recommends in line fianal filtration for all TPN...Lipid globules >5 microns could lodge in the pulmonary microvasculature and produce an embolic syndrome."

Infusion Therapy in Clinical Practice/INS 2001/ " All parenteral solutions should be filtered...a flter SHOULD Not be used with Lipids only...fat emulsions may or not require filtration, depending on manufacturer'sÂ directions..."

So do you or don't you?Â When your institution is doing thousands of these infusions...patient safety and money have to be thought about...the days of "it seems like a good idea" are long gone.Â

Wed, 08/22/2007 - 11:23

lynncrni

All TPN should be filtered

All TPN should be filtered as indicated by the JPEN articles. Frankly I believe that there is sufficient evidence of particulate matter in all IV fluids to warrant filtering everything but the available evidence does not support this. CDC says that filters are not an infection control measure but they do reduce peripheral phlebitis. In view of all the issues with biofilm growing in catheters, hubs, and needleless connectors, filtering may be a way to reduce this risk, but again no evidence for this yet. 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

Mon, 08/27/2007 - 14:13

Daphne Broadhurst

ASPEN (American Society for

ASPEN (American Society for Parenteral & Enteral Nutrition) has published practice guidelines for "Safe Practices for Parenteral Nutrition Formulations", which recommends "use of an in-line filter with PN can prevent the administration of particulate matter, air, and microorganisms to patients.. A 0.2 micron filter should be used for 2-in-1 formulations. A 1.2- 5 micron should be used for TNAs (3-in-1 systems). Alternatively, a 1.2 micron filter may be used for all PN formulations. (The JPEN articles mentioned above likely refer to these guidelines).

As for administering PN without a filter, the guidelines indicate "A filter that clogs during administration of PN is indicative of a problem and may be replaced but should never be removed entirely."

Our facility uses the 0.22 micron filter for AA/Dextrose infusions & no filter for lipids (although as indicated above a 1.2 filter should be used). For our 3-in-1 systems, we use a 1.2 micron filter.

Daphne Broadhurst

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

Thu, 08/30/2007 - 00:41

Kristin Walker

Our institution states that

Our institution states that all central venous access devices need to have a filter placed on the connecting tubing. I tried to find out the orgin of this policy but was unsuccessful. I can't find it in the Standards of Practice Journal for INS. Does anybody remember this as being a routine practice? Do we not routinely filter infusions of central access devices any longer unless the pt is receiving TPN or any of the other indicated infusates?

Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.

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