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.
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, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
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]
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