Guest kendra494 Posted April 23, 2010 Share Posted April 23, 2010 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. Link to comment Share on other sites More sharing options...
Francesco Cardona Posted April 28, 2010 Share Posted April 28, 2010 Hi I am not familiar with the 2 in 1 or 3 in 1 TPN system, could you briefly explain the concept? Link to comment Share on other sites More sharing options...
Guest kendra494 Posted April 29, 2010 Share Posted April 29, 2010 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. Link to comment Share on other sites More sharing options...
Guest SethNelson Posted June 2, 2015 Share Posted June 2, 2015 Hello, Link to comment Share on other sites More sharing options...
Guest SethNelson Posted June 2, 2015 Share Posted June 2, 2015 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 Link to comment Share on other sites More sharing options...
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