fat emulsion

fat emulsion

Intralipid

Liposyn III

Indications

Action

Pharmacokinetics

Time/action profile

Contraindications/Precautions

Adverse Reactions/Side Effects

Cardiovascular

• chest pain

Respiratory

• intravascular fat accumulation(preterm infants only) (life-threatening)

Gastrointestinal

• hepatomegaly†
• jaundice†
• nausea
• pancreatitis
• vomiting

Local

• phlebitis at IV site (most frequent)

Endocrinologic

• hypertriglyceridemia

Miscellaneous

• fever (most frequent)
• infection (most frequent)
• chills
• hypersensitivity reactions

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Monitor weight every other day in adults and daily in infants and children receiving fat emulsion to assist in meeting caloric requirements.
• Assess patient for allergy to eggs prior to therapy. Acute hypersensitivity reaction with pruritic urticaria may occur in patients allergic to eggs.
• Lab Test Considerations: Monitor triglyceride and fatty acid levels routinely to determine patient’s capacity to eliminate infused fat from the circulation. Lipemia must clear between daily infusions.
  • Monitor hemoglobin, blood coagulation, and platelet count weekly, especially during continuous therapy. Report abnormalities promptly. Therapy may be discontinued.
  • Monitor serum bilirubin, cholesterol, and hepatic function weekly, especially in premature infants to prevent hyperlipidemia.
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.

Potential Nursing Diagnoses

Implementation

• Intravenous Administration

• Fat emulsion should comprise no more than 60% of patient’s total caloric intake. The remaining 40% should consist of carbohydrates and amino acids.
  • Fat emulsion may be administered via peripheral or central venous catheter. Monitor peripheral sites for phlebitis.
  • Infuse fat emulsion via Y-site near the infusion site. 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.
  • Manufacturer does not recommend use of filters during administration, but 1.2-micron filters have been used.
  • Use tubing provided by the manufacturer. Change IV tubing after each dose of fat emulsion.
• Intermittent Infusion: Emulsions that appear oily or that have separated should not be used.30% emulsions must not be infused directly.
  • 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.
  • Maximum hang times for fat emulsion alone or for admixtures with dextrose and amino acids is 24 hr. Discard all unused portions.
• 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. 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.
  • No more than 500 mL of the 10% solution or 250 mL of 20% solution should be infused at one time.
  • 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. If no adverse reactions occur, the rate may be increased to a maximum of 0.25 g/kg/hr.
  • Administer via infusion pump to ensure accurate rate.
• Y-Site Compatibility: ampicillin, cefazolin, cefoxitin, clindamycin, digoxin, dopamine, erythromycin lactobionate, furosemide, gentamicin, isoproterenol, lidocaine, norepinephrine, oxacillin, penicillin G potassium, tobramycin
• Y-Site Incompatibility: amikacin
• Additive Compatibility: Fat emulsion may be admixed (“3-in-1,” all-in-one, triple mix total nutrient admixture [TNA]) 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
• Additive Incompatibility: Although compatibility studies have been done, manufacturer recommends that fat emulsion not be admixed with any other medication.

Patient/Family Teaching

• Explain the purpose of fat emulsion to the patient prior to administration.

Evaluation/Desired Outcomes

• Weight gain.
  • Maintenance of normal serum triglyceride and fatty acid levels.