TNA-Peri Special Precautions

The ability to eliminate fat should be monitored. It is recommended that this is done by measuring serum triglycerides after a fat-free period of 5-6 hours. TNA-Peri are designed for adult patients. Due to composition, TNA-Peri is not suitable for the use in new-borns or infants under 2 years of age.
Disturbances of the electrolyte and fluid balance (e.g. abnormally high or low serum levels of the electrolytes) should be corrected before starting the infusion. Special clinical monitoring is required at the beginning of any intravenous infusion. If any abnormal sign occurs, the infusion must be stopped. Since an increased risk of infection is associated with the use of any central vein, strict aseptic precautions should be taken to avoid any contamination during catheter insertion and manipulation.
TNA-Peri should be given with caution in conditions of impaired lipid metabolism, such as in renal insufficiency, uncompensated diabetes mellitus, pancreatitis, impaired liver function, hypothyroidism (with hypertriglyceridemia) and sepsis. If TNA-Peri is given to patients with these conditions, close monitoring of serum triglycerides is mandatory.
Serum glucose, electrolytes and osmolarity as well as fluid balance, acid-base status and liver enzyme tests (alkaline phosphatase, ALT, AST) should be monitored.
Blood cell count and coagulation should be monitored when fat is given for a longer period.
In patients with renal insufficiency, the phosphate and potassium intake should be carefully controlled to prevent hyperphosphatemia and hyperkalaemia. The amount of individual electrolytes to be added is governed by clinical condition of the patient and by frequent monitoring of serum levels.
Parenteral nutrition should be given with caution in metabolic acidosis, lactic acidosis, insufficient cellular oxygen supply and increased serum osmolarity.
TNA-Peri should be given with caution to patients with a tendency towards electrolyte retention. Any sign or symptom of anaphylactic reaction (such as fever, shivering, rashes and dyspnea) should lead to immediate interruption of the infusion.
The fat content of TNA-Peri may interfere with certain laboratory measurements (e.g. bilirubin, lactate dehydrogenase, oxygen saturation, Hb) if blood is sampled before fat has been adequately cleared from the bloodstream. Fat is cleared after a fat-free interval of 5-6 hours in most patients.
Intravenous infusion of amino acids is accompanied by increased urinary excretion of the trace elements, especially during long-term intravenous nutrition. In malnourished patients, initiation of parenteral nutrition can precipitate fluid shifts resulting in pulmonary oedema and congestive heart failure as well as a decrease in the serum concentration of potassium, phosphorus, magnesium and water-soluble vitamins. These changes can occur within 24 to 48 hours, therefore slow and careful initiation of parenteral nutrition is recommended together with close monitoring and appropriate adjustments of fluid, electrolytes, minerals and vitamins.
TNA-Peri should not be given simultaneously with blood in the same infusion set due to the risk of pseudo agglutination. In patients with hyperglycaemia, administration of exogenous insulin might be necessary.