Covering TPN solutions

[hehady]

Do you routinely cover TPN solution? How?

[Stefan Johansson]

We don't cover the TPN-bags at all.
(Do manufacturers of TPN constituents have different recommendations, as to whether their products are light-sensitive?)

[hehady]

A number of researchers have demonstarted that covering TPN solutions would decrease peroxide load. We have just finnished a RCT in our institution and we had similar reults. We are updating our guidelines and we are searching for other institutions guidelines

[Hans Joergen]

Some water-soluble vitamins (e.g. riboflavin’s) that are mixed with TPN (we use vaminolac) need to be protected from light. If you don’t, riboflavin will be reduced quite rapidly.

[Stefan Johansson]

Hmm, I will get in touch with our TPN group & the Pharmacy and see hear their opinion on why we don't cover the TPN.

[hehady]

Dear Stefan

Lipids and multivitamines are particularliy involved in peroxides production on exposure to light. Using special bags or covering TPN solutions with alminum foil may be a good practice.

[brian777]

yes, we cover all tpn's adult and neonatal.

[nicurn2083]

We use dark opaque brown bags to cover TPN in our NICU. They help to protect mutliple additives from photo-oxidation.

Jennifer Tucker RN
HCMC
Minneapolis, MN

[jwalden]

Yes, we use the amber plastic bags as well to cover the TPN. TPN arrives from Pharmacy in these bags, and once hung the amber bag is slipped over the TPN bag to keep it covered.

[satyen75]

We have not been covering our TPN as fat soluble vitamins are not available in India. But such vitamins are known to produce peroxideson photooxidation. I will just like to ask how do You check for peroxides ? Is there a special test.

[hehady]

Please refer to the following articles:

1- Chessex P, Harrison A, Khashu M, Lavoie JC.
In preterm neonates, is the risk of developing bronchopulmonary dysplasia
influenced by the failure to protect total parenteral nutrition from exposure to
ambient light?
J Pediatr. 2007 Aug;151(2):213-4.

2: Khashu M, Harrison A, Lalari V, Gow A, Lavoie JC, Chessex P.
Photoprotection of parenteral nutrition enhances advancement of minimal enteral nutrition in preterm infants.
Semin Perinatol. 2006 Jun;30(3):139-45.

3: Lavoie JC, Rouleau T, Gagnon C, Chessex P.
Photoprotection prevents TPN-induced lung procollagen mRNA in newborn guinea pigs.
Free Radic Biol Med. 2002 Aug 15;33(4):512-20.

4: Chessex P, Laborie S, Lavoie JC, Rouleau T.
Photoprotection of solutions of parenteral nutrition decreases the infused load as well as the urinary excretion of peroxides in premature infants.
Semin Perinatol. 2001 Apr;25(2):55-9. Review.

5: Laborie S, Lavoie JC, Chessex P.
Increased urinary peroxides in newborn infants receiving parenteral nutrition
exposed to light.
J Pediatr. 2000 May;136(5):628-32.

6: Baird LL.
Protecting TPN and lipid infusions from light: reducing hydroperoxides in NICU
patients.
Neonatal Netw. 2001 Mar;20(2):17-22. Review.

7: Lavoie JC, Belanger S, Spalinger M, Chessex P.
Admixture of a multivitamin preparation to parenteral nutrition: the major
contributor to in vitro generation of peroxides.
Pediatrics. 1997 Mar;99(3):E6.