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amaguila2009
Drug Osmolarity

I would ask everyone who has had experience dealing with this issue to participate. Please click on this link: www.medscape.com/viewarticle/511168_print. Thanks.

lynncrni
600 to 900 mOsm per liter is

600 to 900 mOsm per liter is from pharmacy literature. They are ignoring the other literature on phlebitis that states over 600 is a virtual guarentee for phlebitis.

1.    Kuwahara T, Asanami S, Kawauchi Y, Kubo S. Experimental infusion phlebitis: Tolerance pH of peripheral veins. Journal of Toxicology Science. 1999;24(2):113-121.
2.    Kuwahara T, Asanami S, Kubo S. Experimental infusion phlebitis: Tolerance osmolality of peripheral venous endothelial cells. Nutrition. 1998;14(6):496-501.
3.    Kuwahara T, Asanami S, Tamura T, Kubo S. Dilution is effective in reducing infusion phlebitis in peripheral parenteral nutrition: An experimental study in rabbits. Nutrition. 1998;14(2):186-190.

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

amaguila2009
PPN formulation

Lynn,

I've communicated this our pharmacist and what I got from her was that there might not really be a way to reduce the mOsml/L without stripping the nutrients in the formulation. For example:

The problem with setting PPN limits to less than 600 mOsm is that we can’t possibly provide adequate nutrition to the patient.  To give you an idea, D5% (D5W) with the same amino acids 3% and electrolytes would still result in an osmolarity of 800 mOsm.  If I also lowered the amino acid concentration to 2.5% (the absolute minimum recommended amount), I would still end up with an osmolarity in the 700s.  Thus, my only option would be to use D5W, 2.5% amino acids, and exclude electrolytes all together.  I can’t imagine that any of these options is a clinically appropriate solution in terms of nutrition.

Do we have anyone from ASPEN on this site to comment on this?

Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]

lynncrni
I am not advocating for

I am not advocating for alteration of the PN solution in such a manner that it will not meet patient's nutritional needs. I am advcoating that virtually none of these PN solutions can safely be infused through a peripheral catheter due to their hyperosmolarity. This means that virtually all PN would require some type of CVC. It is a matter of looking at the catheter outcomes of thrombophlebitis and infiltration/extravasation with this solution through a PIV. 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

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