Total Parenteral Nutrition (TPN)

Preparations

Prepared by
Clinical Pharmacist: Eshraq Al-abweeny
Supervisor of DIC/KAUH
EXT: 41417
Aminoplasmal B.Braun 5%
Aminoplasmal B.Braun 10%
 Aminoven 5%, 10%

Posology and method of administration :

- The daily requirement of amino acids depends on the body weight and the metabolic
conditions of the patient. The maximum daily dose varies with the clinical condition
of the patient and may even change from day to day.

- The recommended infusion period is to provide a continuous infusion for at least 14

hours up to 24 hours, depending on the clinical situation.

- Bolus administration is not recommended. The solution is administered as long as a

parenteral nutrition is required.

Aminoven 5%:
- For administration via a peripheral or central vein as a continuous infusion.

- The usual daily dose Aminoven 5% is 16 - 20 ml of per kg body weight (equivalent

to 0.8 - 1.0 g amino acids per kg body weight) e.g. corresponding to 1120 - 1400 ml
Aminoven 5 % at 70 kg body weight.

- Maximum infusion rate is 2.0 ml of Aminoven 5% per kg body weight per hour
(equivalent to 0.1 g amino acids per kg body weight and hour).

- Maximum daily dose to adults 20 ml of Aminoven 5% per kg body weight/day

(equivalent to 1.0 g amino acids per kg body weight) e.g. corresponding to 70 g amino
acids at 70 kg body weight. For an increased amino acids dosage suitable preparations
are available.

- Maximum daily dose to children and adolescents (2-18 years) 40 ml of Aminoven

5% per kg body weight/day (equivalent to 2.0 g amino acids per kg body
weight/day) but total daily fluid intake must be considered.
Aminoven 10%:
- For administration via a central vein as a continuous infusion.

- The usual daily dose Aminoven 10% is 10 - 20 ml per kg body weight equivalent
to 1.0 - 2.0 g amino acids per kg body weight) e.g. corresponding to 700 - 1400 ml
Aminoven 10% at 70 kg body weight.

- Maximum infusion rate is 1.0 ml of Aminoven 10% per kg body weight per hour
(equivalent to 0.1 g amino acids per kg body weight and hour).

- Maximum daily dose to adults, adolescents and children (from 2 years) 20 ml of

Aminoven 10% per kg body weight/day (equivalent to 2.0 g amino acids per kg
body weight) e.g. corresponding to 1400 ml Aminoven 10% or 140 g amino acids at
70 kg body weight.

Storage
- Keep container in the outer carton. Do not store above 25°C. Do not freeze.

- Use only clear, particle-free solutions and undamaged containers.

- Do not use Aminoven after the expiry date which is stated on the label after Expiry
Date. The expiry date refers to the last day of that month.

- Aminoven should be used with sterile transfer equipment immediately after opening.
- Any unused solution should be discarded.

- Aminoven may be aseptically admixed with other nutrients such as fat

emulsions, carbohydrates and electrolytes. Chemical and physical stability data for a
number of admixtures stored at 4°C for up to 9 days are available from the
manufacturer upon request.

- From a microbiological point of view, TPN admixtures compounded in uncontrolled

or unvalidated conditions should be used immediately. If not used immediately, in-use
storage times and conditions prior to use are the responsibility of the user and should
normally be no longer than 24 hours at 2 to 8°C, unless mixing has taken place in
controlled and validated aseptic conditions.
Lipofundin MCT/LCT 10%
 Lipofundin MCT/LCT 20%
Dosage:
 Soluvit N

- Soluvit N is a lyophilised, sterile, yellow powder of water-soluble vitamins for

intravenous infusion.

- Soluvit N must not be given undiluted.

Dose and method of administration:

Adults and children weighing 10 kg or more:

The recommended daily dosage is the contents of one vial.

The contents of one vial are dissolved by the aseptic addition of 10 mL of one of the
following:

1. Vitalipid N Adult/Infant*

2. Intralipid 10%, 20% or 30%# lipid emulsion for infusion

3. Water for Injections

4. Sodium chloride 0.9% injection

5. Glucose solution for infusion

6. SMOFlipid®

* Vitalipid N Adult is only indicated for use in patients aged 11 years and above

# Intralipid 30% is not recommended in children

Children and Infants weighing less than 10 kg :

Should be given 1/10 (1 mL) of the content of one vial per kg body weight per day.

The contents of one vial are dissolved by the aseptic addition of 10 mL of one of the
following:

1. Vitalipid N Infant*
2. Intralipid 10% or 20%

3. Water for Injections

4. Sodium chloride 0.9% injection

5. Glucose solution for infusion

6. SMOFlipid®

* The mixture Soluvit N and Vitalipid N Infant is not recommended for those
weighing less than 10 kg

Soluvit N may be added to parenteral nutrition admixtures containing carbohydrates,

lipids, amino acids, electrolytes and trace elements provided that compatibility and
stability have been confirmed.

- The reconstituted Soluvit N should be added to the infusion solution under sterile
conditions, immediately before the start of the infusion and used within 24 hours.

- Clear admixtures (e.g. glucose solution or Water for Injections) containing Soluvit N
should be protected from light.

- The reconstituted mixtures with Vitalipid, Intralipid and SMOFlipid must be added
under sterile conditions to Intralipid only. The reconstituted mixtures with Water,
Sodium Chloride 0.9% and Glucose are added under sterile conditions to Intralipid or
glucose solutions for infusion.

Special precautions for storage :

Do not store above 25°C. Protect from light.

Once reconstituted, store 8°C - 15°C. Protect from light.

 Vitalipid ® N Infant and Adult

Vitalipid N Adult is indicated as a supplement in complete intravenous nutrition to

meet the daily requirements of the fat-soluble vitamins A, D2, E and K1.

Vitalipid N Infant is indicated in pediatric patients up to 11 years of age

DOSAGE AND ADMINISTRATION :

- Must be diluted before use:

Adults and children aged 11 years and above:

One ampoule (10 mL) of Vitalipid N Adult is added to 500 mL Intralipid 10% or
20%.

After mixing by gentle agitation, the emulsion is infused as described for Intralipid.

- Vitalipid N Adult should be added aseptically within one hour of the

commencement of the infusion and should be used within 24 hours.

- Vitalipid N Adult can be used to reconstitute Soluvit N. The contents of one vial
of Soluvit N (the daily maintenance dosages of water-soluble vitamins) are
dissolved by the aseptic addition of 10 mL of Vitalipid N Adult and added to the
Intralipid of the nutritional regimen.

Infants and children under 11 years:

- Vitalipid N Infant in a dosage of 1 mL per kg bodyweight per day is added to

Intralipid 10% or 20%.

- The daily dose must not exceed 10 mL.

- After mixing by gentle agitation the emulsion is infused as described for Intralipid.

- Vitalipid N Infant should be added aseptically within one hour of the

commencement of the infusion and should be used within 24 hours.

Storage :

- Store below 25ºC.

- Protect from light and do not freeze.

- Do not use this medicine after the expiry date which is stated on the carton label and
embossed on the ampoule.

- The contents of each ampoule of VITALIPID N should be dissolved first and then
diluted for single infusion only. Any unused VITALIPID N should be discarded.
 Supliven ®( Trace minerals)

- It is given by IV infusion .

- The recommended dose for children over 15 kg is 0.1 ml per kg of body weight
per day.

- The recommended dose for adults is 10 ml (one ampoule) per day.

- Supliven should not be administered to children weighing less than 15 kg.

- Patients with hepatic or renal impairment may receive lower doses.

- It must be diluted prior to use and infused as component of parenteral nutrition or

parenteral solutions. Do not administer undiluted solutions by direct injection into a
peripheral vein.
- Diluted in 100 ml of NS or D5W.( From King Hussein Cancer Center).
- After dilution: The addition of Supliven should be done immediately before the start
of the infusion and should be used within 24 hours. If not used immediately, storage
times and conditions before use are the responsibility of the user and should not
normally exceed 24 hours at 2-8 º C, unless the mixture has been carried out under
controlled and validated aseptic conditions.

Storage/Stability
Store at 20°C to 25°C