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Administering a Fat Emulsion (Lipids)

Purpose: To spare protein in the critically ill patient. To provide a contamination-free mode of delivering lipids. To prevent or correct a deficiency of essential fatty acids. To provide a source of energy for patients with deficient protein intake.

Preparation
● Determine patient’s ability to understand purpose of receiving lipids.
● Assess patient for signs of essential fatty acid deficits; rash; eczema; dry, scaly skin; poor wound healing; and sparse hair.
● Assess patient for predisposing factors that could promote fat emboli, such as anemia, coagulation disorders, abnormal liver, pancreatic, or respiratory function.
● Check IV site of vascular access device for patency, erythema, and edema before infusing solution.
● Check rate of infusion according to prescriber’s orders, and monitor closely.
● Take patient’s vital signs to establish baseline.
● Keep family informed of therapy procedure, possible complications, and any problems related to patient understanding the procedure.

Special Considerations
Elderly and Pediatric Patients
• Monitor closely for adverse reactions, and notify prescriber as needed.

Relevant Nursing Diagnosis
Altered nutrition: less than body requirements related to a deficiency in protein and essential fatty acid intake

Expected Outcomes
● Lipids are infused at the prescribed flow rate and tolerated by patient
● Dressing at the IV or vascular access catheter insertion site remains dry and intact
● IV site remains free of infection and inflammation
● Adequate calories, protein, and essential fatty acids are provided to patients who are unable to ingest them

Implementation
1. Review prescriber’s orders; identify patient; explain purpose and procedure.
Rationale: Confirms that lipids have been ordered; meets patient’s right to be informed and encourages cooperation.

2. Gather equipment and place at bedside; adjust lighting as needed.
Rationale: Enhances organization and provides optimal lighting environment.

3. Wash hands, and don clean gloves.
Rationale: Reduces transmission of infectious microorganisms.

4. Position in bed in supine position.
Rationale: Patient comfort.

5. Make sure lipids are room temperature.
Rationale: Prevents discomfort when infusing.

6. Examine bottle for separation of emulsion into layers or fat globules or for accumulation of froth.
Rationale: Prevents infusion of lipids that are contaminated.

7. Label bottle with patient’s name, room number, date, time, flow rate, and start and stop times.
Rationale: Ensures proper identification.

8. Take vital signs for baseline assessment.
Rationale: Baseline vital signs are needed because an immediate reaction to the lipid solution can occur.

9. Swab stopper on IV bottle with iodophor sponge or alcohol swab and allow to dry.
Rationale: Cleans stopper and prepares for spiking bottle.

10. Connect special IV tubing to bottle, twisting the spike to prevent particles from the stopper falling into the lipids.New tubing is changed with each bottle. Because lipid particles are large, a filter is not used with infusion.
Rationale: Ensures that tubing and container are properly connected; changing tubing with each bottle prevents growth of microorganisms that can cause infection.

11. Hang IV bottle at least 30 inches above IV site.
Rationale: Because of the solution viscosity, lipids need to be at a height to prevent backing up into infusion tubing.

12. Fill drip chamber two-thirds full, gradually open clamp on the tubing, and prime the tubing slowly.
Rationale: Reduces the chance of air bubble formation in the solution by priming the tubing slowly, and removes air in the tubing, preventing air from entering the patient.

13. Attach the primed tubing to the IV site.
Rationale: Allows the start of infusion.

14. If piggybacking lipids into hyperalimentation (TPN), use the port closest to the patient, below tubing filter.
Rationale: Lipids are compatible with TPN and can be piggybacked into the same tubing as long as it is below the filter because the particles are large and will not go through a filter.

15. Ideally, infuse lipids slowly at first; 1.0 mL/minute for adults and 0.1 mL/minute for children.
Rationale: Allows time to see if the body is going to have an adverse reaction to the solution.

16. Monitor vital signs every 10 minutes for the first 30 minutes and observe for side effects, such as chills, fever, flushing, dyspnea, nausea/ vomiting, and allergic reaction. If any of these occurs, stop the infusion, follow protocol, and notify the prescriber.
Rationale: Alerts nurse to patient tolerating or not tolerating the lipid solution and allows decisions concerning emergency measures.

17. If no reactions occur, adjust to prescribed flow rate and continue to monitor according to protocol.
Rationale: Patient is tolerating the solution without complications, and monitoring follows facility protocol for administering lipids.

18. If ordered by prescriber, monitor serum lipids 4 hours after discontinuing the infusion.
Rationale: Incorrect blood values will result if a blood sample is drawn too soon after the infusion is discontinued.

19. Discard partially used bottles.
Rationale: Prevents contamination.

20. Discard bottle and used IV administration set after each use in the proper trash receptacle.
Rationale: Prevents transmission of infectious microorganisms.

21. Remove gloves (if used), and wash hands before leaving the room.
Rationale: Prevents transmission of infectious microorganisms.

Evaluation and follow up activities
● Evaluate patient compliance and tolerance
● Assess nutrition status
● Monitor for adverse events and complications
● Monitor IV site for infiltration and inflammation
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