How to perform appropriate flushing after lipid emulsion administration using totally implantable venous access devices in long-term total parenteral nutrition and home parenteral nutrition.

Ippei Yamaoka,Yu Koyama,Kazuhisa Doi,Takae Yamato,Naoya Okamura

doi:10.1016/j.clnesp.2020.11.019

Ippei Yamaoka, Yu Koyama + Show 3 more

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https://doi.org/10.1016/j.clnesp.2020.11.019

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Journal: Clinical nutrition ESPEN	Publication Date: Dec 18, 2020
Citations: 1	License type: cc-by

Affiliation: Otsuka (Japan), Niigata University

Abstract

There has been no clear evidence regarding the appropriate method of flushing catheters and totally implantable venous access devices (TIVADs) after lipid emulsion (LE) administration. Therefore, the aim of the study was to identify appropriate methods of flushing to minimize residual LE when using TIVADs to ensure the safety of long-term total parenteral nutrition (TPN) and home parenteral nutrition (HPN). A soybean oil LE containing indocyanine green (ICG) was administered from the injection site of the primary infusion set for flowing TPN, and LE dynamics were evaluated by a fluorescence imaging system. TIVADs were connected to the end of the infusion sets. After LE administration, the tubes and chambers were flushed from the injection site using saline at various speeds (20, 40, 60mL/min), with and without pulsation. The washout effect of TPN solution after LE administration followed by flushing was examined, as was the washout effect of size differences in the infusion sets. When the LE was flushed with 20mL of saline immediately after administering the LE using a standard infusion set (inner diameter 2.5mm), the LE still remained in the tubes and chambers under any flushing condition. Flushing the LE from the injection site with 10mL of saline and then flowing >240mL of TPN solution were effective for minimizing residual LE inside the tubes and chambers. When using an infusion set with a small inner diameter (1.0mm), the LE inside the tubes and chambers was almost discharged with ≥20mL of saline immediately after administering the LE. In all settings, flushing with/without pulsation did not affect LE washout efficacy. Flushing immediately with saline ≥10mL and then flowing >240mL of primary PN solution after soybean oil LE administration using the standard infusion set or flushing with 20mL saline immediately after administering the soybean oil LE using the infusion set with a small inner diameter are effective for minimizing the residual LE in the catheter and TIVAD, ensuring the safety of long-term TPN and HPN.

Highlights

Total parenteral nutrition (TPN) is useful for providing almost all nutrients such as amino acids, glucose, lipids, electrolytes, vitamins, Abbreviations: TPN, Total parenteral nutrition; HPN, home parenteral nutrition; CVAD, central venous access devices; TIVADs, totally implantable venous access devices; ICG, indocyanine green; ANOVA, analysis of variance; Elneopa NF No injection (EP), Elneopa NF No 2 injection; lipid emulsion (LE), Lipid emulsion; AIO, one/all-in-one.and/or TIVADs, it is very important to prevent complications, such as accumulated deposits, occlusion of devices, and bloodstream infection; appropriate management of CVADs and TIVADs is necessary [4]
This paper presents the complete results of our investigation of flushing to minimize residual LE when using a TIVAD to ensure the safety of long-term TPN and HPN
In model A, ICG fluorescence inside the tube was not detected when 240 mL of EP was flowed after administration of LE, but ICG fluorescence inside the chamber was still strongly detected (Fig. 4A a & b)

Summary

Introduction

Total parenteral nutrition (TPN) is useful for providing almost all nutrients such as amino acids, glucose, lipids, electrolytes, vitamins, Abbreviations: TPN, Total parenteral nutrition; HPN, home parenteral nutrition; CVAD, central venous access devices; TIVADs, totally implantable venous access devices; ICG, indocyanine green; ANOVA, analysis of variance; EP, Elneopa NF No 2 injection; LE, Lipid emulsion; AIO, one/all-in-one.and/or TIVADs, it is very important to prevent complications, such as accumulated deposits, occlusion of devices, and bloodstream infection; appropriate management of CVADs and TIVADs is necessary [4]. The aim of the study was to identify appropriate methods of flushing to minimize residual LE when using TIVADs to ensure the safety of long-term total parenteral nutrition (TPN) and home parenteral nutrition (HPN). Flushing the LE from the injection site with 10 mL of saline and flowing >240 mL of TPN solution were effective for minimizing residual LE inside the tubes and chambers. Conclusions: Flushing immediately with saline 10 mL and flowing >240 mL of primary PN solution after soybean oil LE administration using the standard infusion set or flushing with 20 mL saline immediately after administering the soybean oil LE using the infusion set with a small inner diameter are effective for minimizing the residual LE in the catheter and TIVAD, ensuring the safety of long-term TPN and HPN.

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