Errors in Intralipids

Newborn Intensive Care Units (NICUs) are often thought of as helping premature infants. However, they also seek to serve full-term infants with a variety of medical conditions that prevent their ability to be discharged home. Some of those conditions include congenital heart defects, neurological insults and gastrointestinal complications. Many of the infants in all of the categories listed above are not able to receive all or any part of their nutrition through traditional means; either by breast feeding or bottle feeding. Another portion is not able to receive their nutrition even through tube feedings.

The alternative for these infants is nutrition provided through intravenous lines. It is clinically referred to a Hyperailmentation (HAL) and Intralipids. It is also often referred to as Total Parental Nutrition (TPN). TPN is a method of feeding that bypasses the gastrointestinal tract. TPN delivers a mixture of fluid, electrolytes, calories, amino acids, vitamins, minerals and fats into the infant’s veins. Because the additives of TPN are much more complete than regular IV fluids, the infant benefits from a better level of nutrition. Often times, infants who are receiving TPN for any significant length of time have a central line placed. The central IV line allows for higher concentration of nutrients to be delivered to the infant. Intralipids are fat emulsion that can provide neonates with appropriate calories, essential fatty acids and fat soluble vitamins that will lead to effective growth and development.

Unfortunately, as good as the benefits of Total Parental Nutrition are, errors do occur. In fact, medication errors related to intralipid therapy have been reported in every phase from prescribing to administration. Medication errors that occur during intralipid administration often cause health problems to an already fragile population. Some of the noted adverse effects have been fat embolism, hypertension, respiratory distress, liver dysfunction and death.

The leading types of errors that have been noted with intralipid medication errors include; improper dose/quantity, wrong administration technique, omission errors, and wrong time errors. Wrong technique errors can include improper programming of the infusion pump and intralipids being given via a feeding tube instead of IV. Errors involving feeding tube connection can occur because intralipids are white and can resemble breastmilk or formula. Two of the leading types of intralipid medication errors were performance error and improper use of the infusion pump. These errors often led to improper dosing – both over and under dosing.

Medical institutions have looked at many ways to prevent these medication errors from occurring. Some of those have included tubing lines that are not able to be connected to feeding tubes, double-check systems, and standardization of infusion pumps throughout the institution. Units that adopt policies and procedures which are uniformly practiced among ordering physicians can also prevent errors by streamlining the process.

If you have a case that involved a potential error with total parental nutrition administration, intralipids or intravenous fluids, contact our office for assistance with you case.

References:
Santell, J.P et al. USP Patient Safety CAPS Link: Examining Intralipid Errors in the Neonatal Intensive Care Unit (February 2007). Retrieved December 2007 from www.usp.org/pdf/EN/patientSafety/capsLink2007-02-01.pdf.

Greene, Alan et al. Medical Encyclopedia: Total parental nutrition – infant. (September 2007) Retrieved January 2008 from www.nlm.nih.gov/medlineplus/ency/article/007239.htm.