What is the role of filters in parenteral nutrition (PN)?
Nishikawa is an employee of Nutrishare, Inc. G. S. Sacks is an employee of Fresenius Kabi. Intravenous in-line filters play a critical role in promoting patient safety during parenteral nutrition (PN) administration. Guidelines for using filters for PN have been issued by a number of professional organizations and manufacturers of PN components.
What type of filter should be used for Pn administration?
The 2004 ASPEN document addressing Safe Practices for PN discusses the use of filters for PN administration. 36 The practice recommendations called for using a 0.22-micron filter for dextrose–amino acids (2-in-1) admixtures and a 1.2-micron filter for TNAs.
Should PN admixtures be filtered?
ASPEN recommends that healthcare organizations that do not filter PN admixtures or ILE reevaluate these decisions and consider the small price of filters in comparison to increased morbidity and mortality that may result from not filtering ILE or PN.
Where should the filter be placed for peritoneal dialysis (TNAS)?
For TNAs, place the filter as close to the catheter hub as possible. For dextrose-amino acid admixtures below the Y-site where the dextrose-amino acid admixture and the ILE co-infuse. The safety of using a single 1.2 micron filter for PN administration is supported by decades of experience in hospital and homecare settings.
Do you put a filter on TPN?
The use of an in-line, 1.2-micron filter is recommended for the infusion of total parenteral nutrition (TPN), also known as 3-in-1 or all-in-one [AIO], and intravenous fat emulsions (IVFE) infused alone through a separate IV line.
Is filtration required for parenteral nutrition?
The Institute for Safe Medication Practices (ISMP) lists parenteral nutrition (PN) as a high-alert medication due to its high potential for adverse events. Filtration during preparation or administration is an important strategy to minimize harm from parenteral solutions including PN.
What type of filter is recommended for parenteral nutrition?
Historically it has been recommended to use a 0.22-micron filter for the dextrose-amino acids admixture and a 1.2-micron filter for lipid injectable emulsions (ILE) or for total nutrient admixtures (3-in-1 admixture).
Why are IV filters needed?
This filtration is intended to protect the patient receiving the medication by filtering out particulate matter, bacteria, and air emboli, protecting the patient from phlebitis due to particulates or infection due to bacteria. Filters are used with the intravenous administration of many medications.
Can you run lipids without a filter?
Filtering is required of some IV lipid products available on the market in the United States. For lipid injectable emulsion (Clinolipid; Baxter, Deerfield, IL) and IVFE Intralipid, a 1.2 micron or larger filter is required.
What is the most common complication of TPN?
Fatty liver is the most common complication, whereas intrahepatic cholestasis or hepatitis are less frequent.
Why is TPN given through a central line?
Historically, total parenteral nutrition (TPN) has been administered by the central venous route because of the rapid development of thrombophlebitis when TPN solutions are administered into peripheral veins.
What is a 1.2 micron filter used for?
There are two main IV filter pore sizes; the 0.2 micron filter is used for aqueous solutions, and the 1.2 micron filter is recommended for larger molecule solutions such as lipids. The 0.2 micron filter has also been reported to remove air, microorganisms and particulate matter.
Can TPN be given through a peripheral IV?
TPN may not be administered via peripheral intravenous catheter due to high osmolarity. For peripheral administration (PPN), PN solutions must be formulated below 900 mOsm.
What does a 0.22 micron filter remove?
Filters with a pore size of 0.22 micron or less will trap bacteria. Positively charged membranes will also remove endotoxins. Ultrafilters can remove micro-organisms and large organic molecules including nucleases and endotoxin.
What is an air filter in an IV?
Air eliminating filters are used in infusion sets for the dual purpose of filtering particulates and eliminating bubbles. Filters are comprised of a housing with a vented side, separated from the patient side by a 0.2 or 1.2 micron filter membrane.
What can pass through a 0.22 micron filter?
Pseudomonas aeruginosa, Serratia marcescens, and Listeria monocytogenes passed through a 0.3- micro m pore size filter. P. aeruginosa passed through a 0.22- micro m pore size filter. The membranes which allowed passing-through of bacteria showed normal bubble point values in the integrity test.
What is a 0.2 micron filter used for?
Filtration of liquids through 0.2-microm filters is a common and often-used method for the removal of microorganisms from heat-sensitive solutions. Such 0.2 microm filtrations are frequently referred to as 'sterile filtration', reflecting the general belief that all living organisms are excluded from the filtrate.
What's the difference between TPN and PPN?
Total Parenteral Nutrition (TPN) is the delivery of nutrients sufficient to meet metabolic requirements. Peripheral Parenteral Nutrition (PPN) is the delivery of nutrients via a peripheral vein.
How do you administer TPN and lipids?
3:414:43Peripheral Parenteral Nutrition with Lipid (Fat) Emulsion - YouTubeYouTubeStart of suggested clipEnd of suggested clipLipid or fat emulsion infusion insert the end of the sterile primed lipid emulsion tubing into theMoreLipid or fat emulsion infusion insert the end of the sterile primed lipid emulsion tubing into the side port of the ppn iv tubing close to the patient. But below the infusion filter on the ppn.
What is a 1.2 micron filter used for?
There are two main IV filter pore sizes; the 0.2 micron filter is used for aqueous solutions, and the 1.2 micron filter is recommended for larger molecule solutions such as lipids. The 0.2 micron filter has also been reported to remove air, microorganisms and particulate matter.