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Kristin Walker
FILTER OR NOT TO FILTER
I know this topic has been brought up plenty of times but I'm still not satisfied with what I have read.  What are other hosptial's policy in regards to using add-on in line filters?  Our current policy is to use filters on all infusions that are infusing through a CENTRAL VAD.  I couldn't really find any data to regulated the application of this and I was just wondering what other hospitals are doing.  Lynn referred me to an article off the Pall Medical site which made a good arguement to apply filters to ALL IV applications. (Thanks Lynn!).  I think this is a little bit of "over" application but what do all of you gurus think?
lynncrni
Just to go on the record

Just to go on the record here, I think we pay more attention to the filtration of fluids we put in our cars than we do for the fluids we infuse into patients. I have always believed that final filtration was an important aspect of all infusions, but I know the costs of filtration has driven it from common use. We just do not know the long-term affect of the particulate matter being infused! Lynn 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

bartina
Nancy Rose RN IV Team VA
Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext Late comment:

Though I did not see it myself, there was a recent report at my hospital of a significant precipitate with a Moxofloxacin infusion. I was told the visible precipitate ended at the filter. 

Nancy Rose 

cpearson
 The INS is vague as to

 The INS is vague as to filters and says for infusions that require filtration.  I'm not sure who should make that recommendation.

The INS has standards for filtration of lipids and PN.  INS states lipids and TNA should be filtered with a 1.2 micron filter and non-lipid containing solutions with a 0.2 micron filter.  Are facilities following this Standard?   Our policy presently does not filter lipids and I am working on revising the policy.  In practice the lipids are a separate bottle and are the primary line on a pump and then the hyperal solution is filtered with a 1.2 micron filter and added as the secondary line. 

And what about use of non-DEHP administration sets for lipids?

lynncrni
I have just finished

I have just finished reviewing the literature on filtration for the revision of the INS textbook chapter on Equipment. I have always been a strong believer in filtration and am not more convinced than ever before about the benefits of filtration. Parenteral nutrition without lipids in the same container requires filtration with a 0.22 micron filter. Lipids can not be filtered with this size filter and are piggybacked below the filter. When a total nutritent admixture or 3-in-1 solution is used, the lipids dictate that a 1.2 micron filter be used. There is a chance of the fat emulsion to crack when infused this way, posing a greater risk of fat emboli. This filter would stop this. Fat emulsion does cause leaching of DEHP from sets, therefore DEHP-free sets are required.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

cpearson
I still am unclear as to

I still am unclear as to type of filter for a seperate bottle of lipids. 

Thank you, Celia

lynncrni
No filter. Piggyback it into

No filter. Piggyback it into the PN line below the inline 0.22 micron filter. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

cpearson
The INS standards seem like

The INS standards seem like you would still need to filter the lipid bottle.  Would it be appropriate or overuse  to use a 0.2 micron filter on the PN line and a 1.2 filter on the lipids distally?

Celia

lynncrni
You could do it that way.

You could do it that way. Just don't get the filters confused because the fat emulsion will never infuse through the 0.22 micron size. The primary purpose of the filter on the fat emulsion is to stop the infusion of a cracked emulsion, which is much more likely with a 3-in-1 admixture. I have never worked where we filtered fat emulsion when it was piggybacked into the PN line. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

cpearson
One or two other questions

One or two other questions ....If the lipids are piggybacked in would the parenteral nutrition administration set be changed in 72 hours and the lipid line at 24 hours if not sooner?

Do you recommend the 0.2 filter for the PN solution over a 1.2 filter distally to filter PN and the lipds?

Kristin Walker
We change our tubing every
We change our tubing every 24hrs since most pts that are on TPN are also getting Lipids piggybacked.  If they are not getting Lipids, the tubing can be changed in 72hrs, but we decided to change it at 24hrs to keep it simple.

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

Karen Rankin
In our Hospital we use 0.2

In our Hospital we use 0.2 micron filter only for PN (clear Fluid) and the 1.2 micron filter for Lipids - we have an extended life 0.2 micron filter for the clear fluid as we change that line Monday-Wednesday- Friday.  For 3 in 1 (HPN) I use the 1.2 micron filter.  Although there is still limited research I think it is better to be safe - we also use filters in the neonatal population for general IV fluids.

Karen Rankin

Clinical Nurse Consultant

the Children's Hospital at Westmead - Australia

gloria j cottreau
Does anyone have a policy
Does anyone have a policy for using a 0.22micron filter for patients with patent foramen ovale?  Our facility has recently had several patients admitted for joint replacements and it was noted in their chart that they had this defect of the septum (wall) between the two atrial chambers of the heart, making them susceptible for air embolism. Since 1 in 4 may have this defect should (many not knowing they have it) we be using air eliminating filters on all patients?  Thank you, any information will be greatly appreciated.
cpearson
I would love to be referred

I would love to be referred to the article on filtration that is mentioned from the Pall medical site.  I am trying to understand what we hope to filter with different sized filters. 

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