Parenteral Manual

SMOF Lipid 20 %

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Alternate Name(s): 
Soybean oil, medium chain triglycerides, olive oil and fish oil lipid emulsion (6%/6%/5%/3% w/v)
Classification: 
Lipid emulsion for intravenous nutrition
Original Date: 
February 2017
Indications: 
  • Source of energy and essential fatty acids and omega-3 fatty acids, as part of parenteral nutrition regimen when oral or enteral nutrition is impossible, insufficient or contraindicated
Reconstitution and Stability: 
  • Store at room temperature.  DO NOT freeze
  • Stable 24 hours at 25°C after opening
  • Discard any unused emulsion
  • Available as 20% (200 mg/mL) white homogeneous emulsion. DO NOT use if showing  any phase separation
Compatibility: 

The co-infusion of drugs and parenteral nutrition should be avoided.  If a separate site is not available, the drug may be given through a separate line that has a Y-connection to the parenteral nutrition as close to the patient as possible.

- Y-site Compatible:  acetaminophen, ampicillin, cefotaxime, dexmedetomidine, dobutamine, dopamine, epinephrine, fentanyl, furosemide, heparin, hydromorphone, insulin, ketamine, meropenem, metronidazole, midazolam, morphine, norepinephrine, penicillin, piperacillin/tazobactam, vancomycin, zidovudine

- Incompatible:   acyclovir, amiodarone, ceftazidime, ceftriaxone, ciprofloxacin, famotidine, fluconazole, gentamicin, hydrocortisone, milrinone, pantoprazole, rocuronium, sodium bicarbonate, tobramycin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Push NO
IV Intermittent Infusion NO
IN Continuous Infusion YES- via peripheral or central vein
Infusion rate:  do not exceed 0.75 mL/kg/hour
                          (0.15 g/kg/hour)
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Neonates, infants, children:

  • Initial:  0.5 - 1 g/kg/day
  • Increase by 0.5 g/kg/day
  • Maximum:  3 g/kg/day

 

Adolescent/Adult:

  • Standard dose:  1 - 2 g/kg/day  (5 - 10 mL/kg/day)

- 30 - 35% of total daily calories should come from fat
- Maximum of 60% of total daily calories from fat emulsion

Potential hazards of parenteral administration: 
  • Flushing, chest or back pain
  • Thrombophlebitis
  • Sepsis
  • Nausea, vomiting
  • Hyperlipidemia, hepatomegaly
  • Hypersensitivity
  • If fever, chills, rash or dyspnea occurs - stop infusion
Notes: 
  • 20 % lipid = 2 kcal/mL
  • Monitor serum triglycerides, acid base metabolism, CBC, liver function tests, glucose, fluid and electrolytes (all part of regular TPN blood work)  Maintain triglycerides under 3 mmoL/L
  • Also contains the following clinically relevant non-medicinal ingredients:  purified egg phospholipids, all-rac-a-tocopherol
  • Contraindicated in pancreatitis with hyperlipidemia, lipoid nephrosis, severe egg, peanut or soybean allergies
  • Use with caution in patients with severe liver damage, pulmonary disease, anemia or blood coagulation disorder,  jaundiced patients
  • Refer to Fat Emulsion monograph for Intralipid information

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