We currently use a 2 in 1 TPN system in our NICU which is the practice recommended in all the references I have read. A different pharmacist has started coming into our unit (> 25yrs experience but in adult TPN) and is wanting to change to a 3 in 1 system to allow for 30% lipid emulsion to free up slightly more volume.

I cited all the reasons for the 2 in 1 mixture that I am aware of: separate lipid has larger particle size and requires larger pore size filter of 1.2 microns, whereas a 0.22-micron (bacteria-eliminating) filter can be used for "main" bag when lipids are infused separately, and lipid makes it difficult to visualize precipitate or particulate material in the opaque admixture. I have also read some things about the mixture being less stable at certain concentrations of lipid, electrolytes etc. This is hard for me to confirm since I am not a pharmacist.

So my questions is: are there any other contraindications that I have not listed, and is anyone currently using 3 in 1 systems in their NICU? Thanks for your help.

Hi

I am not familiar with the 2 in 1 or 3 in 1 TPN system, could you briefly explain the concept?

Absolutely, 2 in 1 means the lipid component of the TPN is hung separately from the bag containing dextrose, protein, vitamins, minerals and other additives. The 3 in 1 also called TNA (total nutrient ad-mixture) is everything in one bag, which is the norm in adult patients.

Hello,

Hello 

      I am currently doing research on my rotation for a hospital on this exact topic. What sources did you use? Below are two sources that I have found. I also have another PDF that I cannot figure out how to attach in this comment (I am pretty new to the forum). If you would like the study that I have I would be more than happy to email it to you!

 

http://www.ncbi.nlm.nih.gov/pubmed/24667748 

http://www.guideline.gov/content.aspx?id=48024&search=total+parenteral+nutrition