lipid emulsion, injectable

lipid emulsion, injectable

(lip-id ee-mull-shun),

Clinolipid

(trade name)

Classification

Therapeutic: parenteral nutrition
Pharmacologic: lipid calorie sources
Pregnancy Category: C

Indications

To provide a source of calories and essential fatty acids when oral/enteral nutrition is not possible.

Action

Provision of calories and fatty acids which act as substrates for energy production (beta oxidation of fatty acids), also provide membrane structure/function, provide precursor for bioactive molecules and gene expression.

Therapeutic effects

Maintenance of lipid homeostasis during parenteral nutrition.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability; fatty acids are converted to other fatty acids by the liver.
Distribution: Unknown.
Metabolism and Excretion: Metabolized by cell to CO2 and water, which are converted to energy in the form to adenosine triphosphate (ATP). Storage forms allow continual turnover. Excess CO2 is expired via lungs and water is eliminated in urine, skin and other tissue surfaces. Additional lipids may undergo biliary excretion.
Half-life: Unknown.

Time/action profile

ROUTEONSETPEAKDURATION
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Contraindications/Precautions

Contraindicated in: Known hypersensitivity to egg or soybean proteins, lipid emulsion or other contents of product; Severe hyperlipidemia or dyslipidemia.
Use Cautiously in: Hepatic impairment; Severe fluid/electrolyteolic/metab disorders (correct prior to use); ↑ triglyceride levels (initiate at lower dose, advance in small increments); Geriatric: Elderly patients may be sensitive to effects; Obstetric: Use during pregnancy only if clearly needed; Lactation: Use cautiously if breastfeeding; Pediatric: Pre-term/low birth weight infants have poor lipid clearance (deaths have occurred); does not contain sufficient amounts of essential fatty acids for routine use in children.

Adverse Reactions/Side Effects

Gastrointestinal

  • ↑ liver enzymes
  • nausea
  • Parenteral Nutrition-Associated Liver Disease (life-threatening)
  • vomiting

Endocrinologic

  • hyperglycemia

Metabolic

  • fat overload syndrome
  • hypoproteinemia
  • refeeding syndrome
  • ↑ triglycerides

Miscellaneous

  • hypersensitivity reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

May ↓ anticoagulant effect of warfarin (due to soybean oil Vitmain K1 content).

Route/Dosage

Intravenous (Adults) Usual dose— 1–1.5 g/kg/day (not to exceed 2.5 g/kg/day); dose depends on multiple considerations including energy expenditure, clinical status, body weight, tolerance, metabolic status and other energy sources.

Availability

Emulsion for intravenous infusion: 20% lipid emulsion (contains 0.2 g lipids/mL)

Nursing implications

Nursing assessment

  • Monitor for signs and symptoms of hypersensitivity or allergic reactions (tachypnea, dyspnea, hypoxia, bronchospasm, tachycardia, hypotension, cyanosis, vomiting, nausea, headache, sweating, dizziness, altered mentation, flushing, rash, urticaria, erythema, pyrexia, chills) during infusion. Stop infusion immediately and treat symptomatically if symptoms occur.
  • Monitor for signs and symptoms of infections (fever, chills, leukocytosis, hyperglycemia) during therapy. Check parenteral access device frequently.
  • Monitor for signs and symptoms of fat overload syndrome (sudden deterioration in patient condition, fever, anemia, leukopenia, thrombocytopenia, coagulation disorders, hyperlipidemia, liver fatty infiltration or hepatomegaly, deteriorating liver function, coma) during therapy. Usually reversible when lipid infusion is discontinued but may occur when lipid dose exceeded.
  • Carefully monitor severely undernourished patients for signs and symptoms of refeeding syndrome (intracellular shift of potassium, phosphorous, and magnesium as anabolism develops. Thiamine deficiency and fluid retention may develop). Avoid overfeeding and slowly increase nutrient intake to prevent syndrome.
  • Monitor fluid status in patients with pulmonary edema or HF.
  • Lab Test Considerations: Obtain serum triglyceride levels to establish baseline value prior to administering lipids. If triglyceride values are ↑ initiate lipid infusion at a lower dose, advance in smaller increments, and check triglyceride levels before each adjustment.
    • Monitor serum triglycerides, fluid and electrolyte status, serum osmolarity, blood glucose, liver and kidney function, CBC with platelets and coagulation parameters periodically during therapy. Reduce dose of lipid infusion in patients with serum triglycerides >400 mg/dL.
    • Monitor for essential fatty acid deficiency (EFAD) using serum fatty acid levels.
    • May interfere with anticoagulant activity due to content of Vitamin K.
    • May cause aluminum toxicity in premature infants and patients with impaired kidney function who receive aluminum levels >4 to 5 mcg/kg/day. Clinolipid contains no >25 mcg/L of aluminum.

Potential Nursing Diagnoses

Imbalanced nutrition: less than body requirements (Indications)

Implementation

  • Correct severe water and electrolyte disorders, severe fluid overload states, and severe metabolic disorders before infusion of lipids.
  • Intravenous Administration
  • Continuous Infusion: Check color of oxygen indicator before opening overwrap. Compare color of indicator to reference color printed next to OK symbol on indicator label. If color of oxygen indicator does not match reference color do not use solution. Once open use contents immediately; do not store for subsequent infusion. Emulsion should be homogenous milky liquid; do not administer solutions that are discolored or contain particulate matter.
  • Rate: Do not exceed 0.1 g (equal to 0.5 mL)/min for first 15 to 30 min of initial infusion. Gradually increase to required rate after 30 min, if tolerated. Duration of parenteral nutrition bag should be 12 to 24 hr depending on clinical status. Do not connect flexile bags in a series, fully evacuate gas from flexible bags, and do not use vented IV administration set with vent in open position; may cause air embolism. Use a 1.2 micron in-line filter during infusion. Do not use infusion sets and lines containing di-2–ehtylhexyl phthalate (DEHP). If infused alone may be administered via central or peripheral vein. If mixed with dextrose or amino acids, osmolarity of final infusate should determine venous route.
  • Additive Compatibility: If mixed with dextrose or amino acid solutions check mixture closely for presence of precipitates to determine compatibility. To mix, transfer dextrose to total parenteral nutrition admixture container. Then transfer amino acids. Then transfer lipid emulsion. Do not add additives directly into lipid emulsion. Use gentle agitation to mix after each additive. Inspect for separation (yellowish streaking or accumulation of yellowish droplets in admixed emulsion); discard if observed.

Patient/Family Teaching

  • Explain purpose of lipid infusion to patient.
  • If patient is trained to self-administer lipid infusion at home instruct patient to inspect bag for particulate matter and evenly distributed liquid, ensure in-line filter is used, and emphasize need for periodic lab tests. Advise patient to notify health care professional immediately if signs and symptoms of infection or allergic reaction occur.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Maintenance of lipid homeostasis.