- Source of calories and essential fatty acids and omega-3 fatty acids to patients needing parenteral nutrition therapy
- IV continuous infusion through a peripheral or central catheter
- Initiate a 1 g/kg/day and advance daily by 0.5 - 1 g/kg/day to target dose of 3 g/kg/day
- Lower dosage is recommended with hyperbilirubinemia and severe liver insufficiency.
- Endocrine and metabolic : blood triglycerides increased
- Hepatic: cholestasis, hyperbilirubinemia, abnormal hepatic function tests
- Triglycerides (daily while increasing dose then weekly once stable)
- Liver functions tests
- Coagulation parameters (monthly)
- Syringe hang time: 24 hours
- Tubing change time: 24 hours
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
- 20% lipid = 2 Kcal/mL
- Emma L Ross, PharmD, BCPPS, Allison Salinas, PharmD, Kirsten Petty, PharmD, Cheng Her, PhD, John F Carpenter, PhD, Compatibility of medications with intravenous lipid emulsions: Effects of simulated Y-site mixing, American Journal of Health-System Pharmacy, Volume 77, Issue 23, 1 December 2020, Pages 1980–1985, https://doi.org/10.1093/ajhp/zxaa299