To filter or not to filter???Â
Liposyn II insert reads/ " 1.2 micron filter CAN  be used can be used for 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's directions..."
So do you or don't you? 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
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
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
Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.