Additive Compatibility: Fat emulsion may be admixed (“3-in-1,” all-in-one, triple mix total nutrient admixture ) or administered simultaneously with amino acid and dextrose solutions, Intralipid is compatible with FreAmine II 8.5%, Travasol without electrolytes 8.5% and 10%, Veinamine 8%, cimetidine, famotidine, hydrocortisone, multivitamins, nizatidine, dextrose 10% and 70%, While not generally recommended, heparin may be added in a concentration of 1–2 units/mL prior to administration to increase clearance rate of lipemia, minimize risks associated with hypercoagulability, and prevent catheter thrombosis. Y-Site Compatibility: ampicillin, cefazolin, cefoxitin, clindamycin, digoxin, dopamine, erythromycin lactobionate, furosemide, gentamicin, isoproterenol, lidocaine, norepinephrine, oxacillin, penicillin G potassium, tobramycin.Administer via infusion pump to ensure accurate rate.If no adverse reactions occur, the rate may be increased to a maximum of 0.25 g/kg/hr. Pediatric: For children, the initial infusion rate should be 0.1 mL/min of the 10% solution and 0.05 mL/min for the 20% solution for the first 10–15 min.No more than 500 mL of the 10% solution or 250 mL of 20% solution should be infused at one time.If no adverse reactions occur, the rate may be increased to infuse 50 mL/hr for the 20% solution or 100 mL/hr for the 10% solution. Rate: For adults, the initial infusion rate should be 1 mL/min for the 10% solution and 0.5 mL/min for the 20% solution for the first 15–30 min.Maximum hang times for fat emulsion alone or for admixtures with dextrose and amino acids is 24 hr.Pediatric: Avoid use of 10% emulsion in preterm infants a greater accumulation of plasma lipids occurs due to the greater phospholipid load of the 10% emulsion.Intermittent Infusion: Emulsions that appear oily or that have separated should not be used.30% emulsions must not be infused directly.Change IV tubing after each dose of fat emulsion. Use tubing provided by the manufacturer.Manufacturer does not recommend use of filters during administration, but 1.2-micron filters have been used.Because of the lower specific gravity, the fat emulsion solution must be hung higher than the amino acid and dextrose solutions to prevent the fat emulsion from backing up into the amino acid and dextrose line. Infuse fat emulsion via Y-site near the infusion site.Fat emulsion may be administered via peripheral or central venous catheter.The remaining 40% should consist of carbohydrates and amino acids. Fat emulsion should comprise no more than 60% of patient’s total caloric intake.Potential Nursing DiagnosesImbalanced nutrition: less than body requirements (Indications)ĭeficient knowledge, related to medication regimen (Patient/Family Teaching) If signs of overloading syndrome (focal seizures, fever, leukocytosis, splenomegaly, shock) or elevated triglyceride or free fatty acid levels occur, infusion should be stopped and the patient re-evaluated prior to reinstituting therapy. Monitor serum bilirubin, cholesterol, and hepatic function weekly, especially in premature infants to prevent hyperlipidemia.Monitor hemoglobin, blood coagulation, and platelet count weekly, especially during continuous therapy.Lipemia must clear between daily infusions. Lab Test Considerations: Monitor triglyceride and fatty acid levels routinely to determine patient’s capacity to eliminate infused fat from the circulation.Acute hypersensitivity reaction with pruritic urticaria may occur in patients allergic to eggs. Assess patient for allergy to eggs prior to therapy.Monitor weight every other day in adults and daily in infants and children receiving fat emulsion to assist in meeting caloric requirements.Emulsion for IV Use: 10%, 20%, 30% Nursing implications Nursing assessment
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