Parenteral Nutrition Filtration

The Use of Intravenous (IV) In-line Filters in Parenteral Nutrition (PN)

“The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends that healthcare organizations that do not filter PN admixtures or ILE (Lipid Injectable Emulsion) reevaluate these decisions and consider the small price of filters in comparison to increased morbidity and mortality that may result from not filtering ILE or PN.”1

First Recommentation for the use of IV In-line Filter

Read more

 

In 1994, FDA required the use of filters due to reports of interstitial pneumonitis and death associated with calcium-phosphate precipitation in an unfiltered peripheral Total Nutrient Admixture (TNA) formulation. Subsequently, the use of a 0.22- µm in-line filter for PN without ILEs (Lipid Injectable Emulsion) and the use of a 1.2 µm in-line filter for TNA formulations have been recommended.2

 

Nowadays, the strategic approach in practice can be different from one country or region to another but using in-line filters during PN is a widely used strategy to minimize harm from particulates and microbial contaminants exposure.

 

 “The consensus for in-line filter use as it relates to PN and ILE (Lipid Injectable Emulsion) infusions is evident in the literature.” 3

 

 

References

What is Parenteral Nutrition (PN)?

Read more

The American Society for Parenteral Nutrition (ASPEN) defines PN as “an intravenous administration of nutrition, which may include protein, carbohydrate, fat, minerals and electrolytes, vitamins and other trace elements for patients who cannot eat or absorb enough food through tube feeding formula or by mouth to maintain good nutrition status. Achieving the right nutritional intake in a timely manner can help combat complications and be an important part of a patient’s recovery. Parenteral nutrition is sometimes called Total Parenteral Nutrition (TPN)”.1

 

PN could therefore be defined as being clear fluid PN or lipid containing PN dependent on its formulation.

 

Safety concerns with all parenteral solutions include the potential exposure of patients to particles and pathogens2. ICU patients are particularly at risk due to the need for prolonged PN therapy.

 

Eventually, the Institute for Safe Medication Practices (ISMP) lists PN as a high-alert medication due to its high potential for adverse events3. The ISMP's list determines which medications in medical organizations require special safeguards to reduce the risk of errors and minimize harm.

 

References

How Many Patients receive Parenteral Nutrition (PN) in the United States?

Read more

Lipid containing and/or clear fluid PN is received by both hospitalized patients and patients at home. According to the 2014 National Inpatient Survey data (latest available statistics), the annual number of patients receiving a PN solution increased significantly from 25,075 in 2001 to 33,435 in 2014 and peaked at 43,350 in 2012 in the United States1. It is estimated that 25,000 patients are receiving parenteral nutrition at home (Medicare beneficiary data for 2013)2.

 

References

Particle-related Safety Concerns associated with Parenteral Nutrition (PN)

Read more

Particles in PN Solutions

 

All intravenous fluids, including PN solutions may contain unintentional particles1. These particles may arise from intrinsic sources, such as the infusion equipment, packaging material, solution and formulation components, product–package interactions, or extrinsic sources, such as contamination from the environment or personnel2. Further, precipitates or particles resulting from drug incompatibilities are of major concern, especially since information about which drugs are compatible with PN during Y-site administration is still limited3.

 

References

How many Particles are in Parenteral Nutrition (PN) Solutions?

Read more

Researchers conducted studies to count the number of particles and their sizes in infusion regimes, including PN solutions over the last years.

 

Benlabed et al. counted 8256 particles over a 6-h infusion period in an experiment mimicking a clear fluid parenteral nutrition infusion regime for adult ICU patients with the continuous infusion of norepinephrine, midazolam, sufentanil, heparin, 5% glucose, binary parenteral nutrition, and discontinuous administrations of omeprazole, piperacillin/tazobactam and fluconazole1. Table 1 illustrates the size distribution of the counted particles.

 

Table 1: Number of particles over the 6-h infusion period1

 

Particle size

>1 µm

>10 µm

>25 µm

Number of particles

8256

281

19

 

Oie et al. counted the particles contained in the remnants of unadmixed and admixed clear fluid parenteral nutrition solutions. The mean number of particles ≥ 1.3 µm in the 192 residual solution samples examined in this study was 960.9/ml. Since the mean residual solution volume was 50 ml, there were 48.000 (960x50) particles ≥1.3 µm in diameter per bag.2 Table 2 illustrates the number and size distribution of the counted particles.

 

Table 2: Mean of particles/ml in in-use various parenteral nutrition solution2

 

Particle size

>1.3 µm

>5 µm

>10 µm

>50 µm

Number of particles in unadmixed solutions

63

2

0.4

0

Number of particles in admixed solutions

961

43

6

0.1

Number of particles in solutions mixed with 1- 3 glass ampoules

862

31

4

0.1

Number of particles in solutions mixed with 4 - 13 glass ampoules

1163

66

11

0.1

 

Ball et al. examined in an observational study the number, size distribution, and sources of particulate contamination in lipid containing PN (adult (all-in-one) solutions, pediatric (two-in-one) solutions, and syringe-packed lipid emulsions)3.  Large numbers of particles were found, and information gained about their possible origin. Table 3-5 illustrate the number and size distribution of the counted particles.

 

Table 3: Mean particle counts per mL and size ranges in adult (All-In-One) solutions3

 

Particle size

3-5 µm

>5 µm

>10 µm

>25 µm

>40 µm

Number of particles (µm)/1 mL in first 30 mL

3.47

1.4

0.96

1.06

0.06

Number of particles (µm)/1 mL in second 100 mL

0.90

0.42

0.29

0.24

0.15

 

 

Table 4: Mean particle counts per mL and size ranges In pediatric (All-In-One) solutions3

 

Particle size

3-5 µm

>5 µm

>10 µm

>25 µm

>40 µm

Number of particles (µm)/1 mL in first 50 mL

7.59

11.77

1.43

0.38

0.16

Number of particles (µm)/1 mL in second 50 mL

5.72

9,23

0.80

0.34

0.16

 

 

Table 5: Mean particle counts per mL and size ranges in syringe-packed lipid emulsions3

 

Particle size

3-5 µm

>5 µm

>10 µm

>25 µm

>40 µm

Number of particles (µm)/1 mL in first 5 mL

16.72

8.98

1.27

0.76

0.44

Number of particles (µm)/1 mL in second 5 mL

15.55

9.83

1.35

0.69

0.42

 

 

Puntis et al. counted the number of particles for parenteral feed infusions compounded for a 3000 g infant according to standard nutritional regimens. They found approximately 37.000 particles between 2 and 100 µm in size in one day's feed, of which 80% were derived from the fat emulsion4. Table 6 illustrates the number and size distribution of the counted particles.

 

Table 6: Mean particle counts and sizes ranges per 10 ml of amino acid / dextrose solution and per 35 ml of Intralipid 10%4

 

Particle size

2-5 µm

5-10 µm

10-25 µm

25-40 µm

40-100 µm

Number of particles in amino acid / dextrose

151

44

13

4

2

Number of particles in lipid emulsion

5881

766

729

4

2

 

 

References

Microorganism-related Safety Concerns associated with Parenteral Nutrition (PN)

Read more

Microbial growth in PN solutions

 

Lipid containing PN solutions are often considered as an ideal microbial growth medium, and slow administration at room temperature offers the opportunity for microbes to multiply and cause adverse effects1. Austin et al. identified in a systematic review additional factors that may influence microbial growth in lipid containing PN solutions1.

 

  • “Microbial growth was very variable and predominantly influenced by microbial species. Some microbes grew rapidly in both lipid and lipid-free PN (e.g. C. albicans and S. marcescens), others grew slowly (e.g. S. epidermidis and P. aeruginosa), and yet others were killed in both lipid and lipid-free PN while being able to grow in lipid alone (e.g. E. cloacae). It is also possible for an organism to be killed in lipid alone but to grow in both lipid and lipid-free PN (e.g. E. durans)”.
  • “Microbial growth can be influenced  substantially by nutrients other than lipid, and by the physicochemical characteristics of PN.”
  • “Another potentially modifiable risk factor is infusate pH, which affected the growth of several microbes, including S. aureus but not C. albicans”.

 

Overall, the authors conclude that other factors than lipid inclusion can substantially impact microbial growth.

 

Central line-associated bloodstream infections (CLABSIs)

 

Central line-associated bloodstream infections (CLABSIs) are the most common and serious complications for patients with intestinal failure receiving lipid containing PN2-5. The overall incidence of CLABSIs in patients receiving PN ranges from 0.38 to 4.58 episodes per 1000 catheter days and account for nearly 70% of all hospital admissions6-8. S. aureus is the causative pathogen in approximately 10–26% of the cases6,9-12 and S. aureus bacteremia (SAB) is associated with high complication rates.

 

Outbreaks due to Parenteral Nutrition Solutions

 

In the past, several species of microorganisms have been involved in PN-related outbreaks. Table 7 summarizes published PN-related outbreaks since 2011.

 

Table 7: PN-related outbreaks since 2011

 

Year

Country

Cases and outcome

Identified Bacteria

202013

Mexico

Three pediatrics patients hospitalized for different reasons became bacteremic over a period of two days. One newborn preterm died.  The only characteristic related to all cases was the use of TPN.

Blood cultures showed growth of Cupriavidus pauculus.

201914

Mexico

For 10 days, 25 patients who received intravenous lipid containing PN from the same batch of a formula developed sepsis.

During the outbreak, a total of 30 L. adecarboxylata isolates were recovered from 25 patients. L. adecarboxylata was also isolated from one sealed, unopened bottle of TPN belonging to the same batch administered to the patients.

201815

South Korea

At an intensive care unit, four neonates died consecutively within 80 minutes. The authors proposed that pulmonary fat embolism as well as fulminant sepsis may be a possible cause of the deaths of the 4 neonates.

Citrobacter freundii was isolated from the blood samples and from the leftover SMOFlipid that had been infused to the neonates.

201616

Turkey

C. albicans was isolated in blood cultures of

seven patients.

C. albicans was the causative agent of blood stream infection in seven patients due to the use of lipid containing PN solution and the use of broad-spectrum antibiotics that was probably contaminated with this strain.

201417

Brazil

Between November 2013 and June 2014, 56 cases of bacteremia (15 deaths) associated with the use of lipid containing PN and/or calcium gluconate were reported in four Brazilian states.

The molecular investigation of the outbreak led to the identification of isolates belonging to three different bacterial species: P. diazotrophicus, A. baumannii and R. radiobacter.

201118

USA

Beginning in January 2011, 19 bloodstream infections (BSIs) occurred in patients receiving PN prepared by a compounding pharmacy. Death occurred in nearly half of these BSI events.

The authors concluded that failure to follow recommended compounding standards contributed to an outbreak of S. marcescens BSIs.

 

 

 

References

Enlarged Lipid Droplets-related Safety Concerns associated with Lipid Containing Parenteral Nutrition (PN)

Read more

Overall, stabilization of lipid containing parenteral nutrition solutions is critical, since destabilization can cause the lipid globules to coalesce, thus causing the particle size to exceed 5 µm. If particle size exceeds 5 µm patients can be at risk of pulmonary capillary occlusion and fat emboli18. The stability can be especially challenging in 3-in-1 parenteral nutrition solution, since the stability is affected by several factors, including pH, final concentration of macronutrients and micronutrients, order of admixture, additive characteristics, and storage and aging of the formulation19.

 

According to the United States Pharmacopeia (USP) 729, lipid solutions must meet the following criteria19:

 

  1. mean droplet size (MDS) must not exceed 500 nm, and
  2. the proportion of lipid globules >5 µm in diameter at the “tail” of the droplet globule-size distribution (GSD) curve cannot exceed 0.05%.

 

Microorganisms in parenteral nutrition solutions may not only have a direct impact on patients’ health leading to sepsis and bacteremia, but also an indirect impact increasing the size of fat globules potentially leading to pulmonary fat embolism14. After a tragic incidence, Bae et al. conducted an in vitro-study to evaluate the increase in number and size of fat globules in SMOFlipid contaminated with C. freundii.

 

  • By 24 hours after the inoculation, many of the large fat globules in SMOFlipid inoculated with C. freundii were > 20 µm in diameter and the size of fat globules increased up to 40 µm.
  • The number of fat globules with > 5 µm in diameter also increased when SMOFlipid was mixed with vancomycin and gentamicin, but not when mixed with ampicillin and cefotaxime.
  • After the filtration of SMOFlipid with a 1.2 micrometer in-line filter, all the large fat globules were not observed13.
 

References

What kind of IV in-line filters could you use for PN solutions?

Read more

The first important factor to select an IV in-line filter is the type of PN solutions.

 

For lipid containing solutions (ILEs(Lipid Injectable Emulsion), all-in-one admixtures), 1.2 µm IV filters are recommended. 0.2 µm filters cannot be used.

 

For clear fluid PN solutions, it may be possible to use 0.2 µm filters. The formulation should be checked for suitability (e.g. microemulsions, vitamins are not suitable).

 

Depending on pore size and charge, IV In-line filters may prevent the entry of inadvertent particulate debris1-7, air8,9, enlarged lipid droplets17,18, microbial contaminants, and their associated endotoxins10-16 into the vasculature of the patient via the infusion line.

 

The benefits of 1.2 µm IV in-line filter

 

1.2 µm IV filters can retain larger inadvertent particulate debris, air, and enlarged lipid droplets. These filters do also have the possibility to retain microbes with a size above 1.2 µm, such as Candida species.

 

The benefits of 0.2 µm IV in-line filter with non-positive charged membranes

 

0.2 µm IV filters can retain smaller inadvertent particulate debris, air, enlarged lipid droplets and smaller microbes, which could include Staphylococcus epidermidis and E coli. Unfortunately, the use of 0.2 µm filters is precluded for lipid containing solutions, since the lipid globule size is above 0.5 µm.

 

The benefits of 0.2 µm IV in-line filter with positive charged membranes

 

0.2 µm IV in-line filters with a positively charged membrane can retain smaller inadvertent particulate debris, air, smaller microbes, and endotoxin. Unfortunately, the use of 0.2 µm filters with a positive charged membranes is also precluded for lipid containing solutions, since the lipid globule size is above 0.5 µm.  

 

References

Managing the risk of enlarged lipid droplets with our 1.2 µm TNA1 IV In-Line Filter

Read more

It is important for commercially available intravenous fat emulsions that the PFAT5 (the percentage of fat droplets with a size >5 µm) is consistently <0.05%. If the PFAT5 level is >0.05%, the lipid emulsions may be instable and potentially harmful to patients1.

 

Driscoll et al. from the Harvard Medical School conducted a study to investigate if

 

  • a commercially available 1.2 µm in-line filter (Pall TNA1 1.2 µm filter) protect against the passage of abnormally large and potentially dangerous lipid droplets (sizes of >5 µm) in a simulated infusion model with a parenteral infusion pump2.

 

The authors noted four results2.

 

  1. The 1.2 µm TNA1 in-line filter reduced significantly clinically meaningful unstable lipid droplets (>5 µm).
  2. Not once in the 24-hour infusion period did the filter occlude nor was the flow rate accuracy of the pump compromised, despite the influence of highly unstable Total Nutrient Admixtures formulations with PFAT concentrations a high as 2.75% in the pre-filtrate.
  3. As the 1.2 µm TNA1 in-line filter was able to trap enlarged and potentially dangerous lipid droplets, it also did not induce instability in the otherwise stable lipid droplets.  
  4. No significant interaction effects were noted between treatment and time.
 

References

Managing the risk of fungi with our 1.2 µm TNA1 IV In-Line Filter

Read more

Does our Pall TNA1 filter retain Candida albicans?

 

Candida species are the most common fungal agents in the patients receiving PN and C. albicans is the leading strain1,2. In parenteral nutrition containing lipids, Candida species can grow rapidly from 102 to 105 cfu/mL within 24 hours3. Lipid containing PN solutions increase the budding and biofilm formation of Candida albicans and may lead eventually to catheter-associated infections and sepsis1,4,5.

 

Candida species hospital outbreaks have been documented following use of contaminated medical devices and/or PN solutions6,7.

 

Our Challenge

 

We tested our 1.2 µm TNA1 in-line filter for C. albicans retention with approximately 1 x 107 CFU/cm2 per cm2 of effective filtration area over a 24-hour period with an infusion rate at 100 mL/hour to simulate clinical usage and the lifetime of the filter8.

 

The Result

 

We observed complete retention of C. albicans (retention rate of 100%) from the 24-hour use study. The results of this testing show our 1.2 µm TNA1 in-line filter can retain C. albicans and acts as a barrier to any inadvertent fungal contaminants8.

 

Does our Pall TNA1 filter retain Malassezia furfur?

 

Malassezia furfur can be a source of serious systemic infections in neonatal intensive care units and this microorganism is capable to survive in fat emulsions for PN. Under conditions similar to the clinical practice, Robinson and Ball have shown that the Pall TNA1 filter can retain Malassezia furfur9.

 

References

Managing the risk of bacteria with our Posidyne® 0.2 µm IV In-Line Filter

Read more

Brevundimonas diminuta is the industry standard bacteria for evaluating bacterial retention characteristics of 0.2 µm filters and was originally selected due to the observation by Dr. Frances Bowman that it could repeatedly penetrate a 0.45 µm rated filter but was fully retained by a 0.2 µm filter1.

 

Our Challenge

 

We tested our smallest Posidyne® 0.2 µm IV in-line filter (NEO96) with B. diminuta with at least > 1 x 107 colony forming units per cm2 of effective filtration area at a flow rate of 10 mL/hour for a period of 96 hours.

 

The Result

 

Our Posidyne® NEO96 0.2 µm IV in-line filter retained ≥ 99.99 % of B. diminuta over the 96 hour usage. The results of this testing show that our 0.2 µm 0.2 NEO96 filters can retain B. diminuta and acts as a barrier to any inadvertent microbial contaminants3.

 

 

References

American Society for Parenteral and Enteral Nutrition (ASPEN)

Read more

In 2021, ASPEN published a position paper to update their recommendations on the use of in-line filters for PN1.

 

Table: ASPEN recommendations on IV in-line filters for PN solutions

 

Regarding the use of IV in-line filters ASPEN recommends the following:

“Based on best available evidence and guidance from scientific and regulatory agencies, ASPEN recommends using a 1.2 micron in-line filter for administration of TNAs, dextrose-amino acid admixtures and ILE (Lipid Injectable Emulsion).”
“Although 1.2 micron filters are not recommended for use as a routine infection control measure, these devices are effective in preventing Candida albicans, a pathogen frequently associated with PN administration, from reaching the patient.”
“ASPEN recommends that healthcare organizations that do not filter PN admixtures or ILE (Lipid Injectable Emulsion) reevaluate these decisions and consider the small price of filters in comparison to increased morbidity and mortality that may result from not filtering ILE or PN.”

Regarding the positioning of IV in-line filters ASPEN recommends the following:

“For TNAs, place the filter as close to the catheter hub as possible. For dextrose-amino acid admixtures below the Y-site where the dextrose-amino acid admixture and the ILE (Lipid Injectable Emulsion)  co-infuse.”

Regarding the ratio for using IV in-line filters the ASPEN position paper states:

“In-line intravenous filters serve a critical purpose in reducing exposure to particulate matter during PN therapy.”
“Particles greater than 2 microns, which are retained by 1.2 micron filters, appear to pose the most serious risk for adverse consequences.”

 

For more information you can download here your 2-page ASPEN fact sheet including best practices for filter use.

 

Additional Considerations regarding lipid injectable emulsion for neonate and pediatric patients

 

In 2021, ASPEN approved a consensus recommendation regarding lipid injectable emulsion for neonate and pediatric patients2.

 

Table: ASPEN recommendations on IV in-line filters for lipid injectable emulsion for neonate and pediatric patients.

 

Regarding the use of IV in-line filters ASPEN recommends the following:

“In the majority of neonatal and pediatric patients, ILE (Lipid Injectable Emulsion) is typically being administered separate from the amino acids–dextrose solution. ILE infusion is usually via a Y-site into the same catheter as the PN. ILE is infused using a 1.2-μm in-line filter located below the bifurcation of the tubing, closest to the catheter hub.”
“When ILE (Lipid Injectable Emulsion)  is infused separate from PN, utilizing a different intravenous vascular access device (VAD), each infusion line (PN and ILE) should include a 1.2-μm filter between the infusion container and the intravenous catheter.”

 

References

Infusion Nursing Society (INS)

Read more

To align with ASPEN, INS published in 2021 an update on their Infusion Therapy Standards of Practice regarding the use of IV in-line filters for PN1.

 

Table: INS recommendations on IV in-line filters for PN solutions

 

Regarding the use of IV in-line filters INS recommends the following:

“Based on best available evidence and guidance from scientific and regulatory agencies, INS recommends using a 1.2 micron in-line filter for administration of TNAs, dextrose-amino acid admixtures and ILE (Lipid Injectable Emulsion).”

Regarding the rationale for using IV in-line filters INS states:

“In-line filters   were    initially developed for infection control purposes, but their role in protecting patients from the harmful effects of particulate matter has emerged as their primary purpose in infusion therapy.”      

 

References

  1. Gorski L.A. et al. (2021). Infusion therapy standards of practice. J Infus Nurs; 44(suppl 1): S1-S224.

European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), European Society for Parenteral and Enteral Nutrition (ESPEN), European Society for Paediatric Research (ESPR) and Chinese Society for Parenteral and Enteral Nutrition (CSPEN)

Read more

In 2018, ESPGHAN/ESPEN/ESPR working group published new guidelines on pediatric parenteral nutrition including recommendation on the IV in-line filters for PN1.

 

Table: ESPGHAN/ESPEN/ESPR recommendations on IV in-line filters for pediatric PN solutions

 

Regarding the use of IV in-line filters ESPGHAN/ESPEN/ESPR recommends the following:

“PN solutions may be administered through a terminal filter: lipid emulsions (or all-in-one mixes) can be passed through a membrane pore size of 1.2-1.5 µm; aqueous solutions can be passed through a 0.22 µm filter (GPP, strong recommendation for, strong consensus.”

Regarding the rationale for using IV in-line filters ESPGHAN/ESPEN/ESPR states:

PN solutions contain particulate matter and biochemical interactions can lead to chemical precipitates and emulsion instability; they also act as a media for microbiologic growth should contamination occur. “
“In critically ill children therefore, it appears that infused particles may impair the microcirculation, induce systemic hypercoagulability and inflammation.”
“The routine use of in-line filtration has been advocated in children receiving large volume parenterals, and a randomised trial in a paediatric intensive care unit showed that filters were associated with a significant reduction in overall complication rate, a reduction in systemic inflammatory response syndrome, and a reduction in length of stay.”

Regarding the selection of  IV in-line filters ESPGHAN/ESPEN/ESPR states:

Some endotoxin retaining 0.22 µm filters allow cost saving, through extended use of the administration set. With the appropriate filters, giving sets can be used for 72-96 h.

Regarding the blockage of  IV in-line filters ESPGHAN/ESPEN/ESPR states:

“Filter blockage is more likely to indicate a problem with the solution than the filter, and must be thoroughly investigated.”

 

References

  1. Puntis J.W.L. et al. (2018) ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Organisational aspects. Clinical Nutrition; 37: 2392-2400.

Irish Society for Clinical Nutrition & Metabolism (IRSPEN)

Read more

In 2020 (revised 2023), the Irish Society for Clinical Nutrition & Metabolism published the Guideline on the Use of Parenteral Nutrition in Neonatal and Paediatric Units1.

 

Table: IRSPEN recommendations on IV in-line filters for neonatal and paediatric PN solutions

 

Regarding the use of IV in-line filters IRSPEN recommends the following:

“It is recommended that all PN solutions are administered via an infusion set containing a terminal filter.”
A 1.2 to 1.5 micron filter is recommended for 3-in-1 admixtures.
The current PN infusion set contains filter membranes with pore sizes of 1.2 micron (lipid line) and 0.2 microns (aqueous line).”

Regarding the rationale for using IV in-line filters IRSPEN states:

“PN solutions may contain particulate matter and biochemical interactions can result in chemical precipitations in addition to the risk of bacterial contamination.”

 

References

  1. Irish Society for Clinical Nutrition & Metabolism. 2020. Guideline on the Use of Parenteral Nutrition in Neonatal and Paediatric Units. Accessed from https://www.hse.ie/eng/about/who/cspd/ncps/paediatrics-neonatology/resources/guideline-on-the-use-of-parenteral-nutrition-in-neonatal-and-paediatric-units.pdf

French Health Authority (HAS)

Read more

In 2018, the HAS published the guideline on the use for PN1.

 

Table: HAS recommendations on IV in-line filters for neonatal PN solutions

 

Regarding the use of IV in-line filters HAS recommends the following:

“Use antibacterial (0.22 µm) and particulate (1.2 µm) in-line filters. Antibacterial filters cannot be used with lipids.”

 

References

  1. Haute Autorité de Santé (2018) Recommandation de bonne pratique. Nutrition parentérale en néonatologie

British Pharmaceutical Nutrition Group Working Party (BPNG)

Read more

In 2001, the British Pharmaceutical Nutrition Group Working Party published a position paper and guidelines on the use of filters during the preparation and administration of parenteral nutrition1.

 

Table: BPNG recommendations on the use IV in-line filters for PN solutions

 

Regarding the use of IV in-line filters BPNG recommends the following:

“The 1.2-µm filters should be used for the administration of lipid-containing solutions including AIO admixtures and changed every 24 h.”
“The 0.2-µm endotoxin-retaining filters should be used for the administration of non–lipid-containing solutions and can be changed every 96 h.”
Appropriate filters should be used during the administration of PN to patients who require intensive or prolonged parenteral therapy, the immunocompromised, neonates and children, and patients receiving home PN because of the large volume of potentially particulate-contaminated fluid administered and their increased susceptibility to the detrimental effects of particulate contamination.” 

Regarding the positioning of IV in-line filters BPNG recommends the following:

“When used, in-line filters should be placed as close to the patient as possible.”

Regarding the rationale for using IV in-line filters the BPNG position paper states:

The use of the appropriate filter during the administration of PN will remove:

 

  • particulate contamination
  • bacterial contamination
  • endotoxins (if a 0.2-µm filter with positively charged membrane is used)
  • precipitates
  • large lipid globules and free oil.”

Appropriate filters should be used during the administration of PN to patients who require intensive or prolonged parenteral therapy, the immunocompromised, neonates and

children, and patients receiving home PN because of the large volume of potentially particulate-contaminated fluid administered and their increased susceptibility to the detrimental effects of particulate contamination. These patients also would benefit from the use of filters during the administration of intravenous drugs and fluids.”

 

References

  1. Bethune K. et al. (2001). Use of Filters During the Preparation and Administration of Parenteral Nutrition: Position Paper and Guidelines Prepared by a British Pharmaceutical Nutrition Group Working Party. Nutrition;17(5): 403-8

Our SLS & Clinical Specialists Are Here to Help You

Read more

 

Our highly skilled technical experts in our “Scientific Laboratory Services” (SLS) are here to support you and offer advice on optimal intravenous filtration and infusion solutions or to perform drug compatibility studies.

 

Our Clinical Specialists support customers who wish to implement Pall intravenous, breathing and gas filtration devices. They implement and evaluate our products in hospitals at the patient’s bedside and advise on any problems that might arise.

 

You can reach them easily via your local sales rep or through customer services.