Kabiven/Kabiven Peripheral 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 hrs. The serum concentration of triglycerides should not exceed 3 mmol/L during infusion.
The bag size, specially the volume and the quantitative composition, should be carefully chosen. These volumes should be adjusted according to the hydration and nutritional status of the children. One reconstituted bag is for single use.
Disturbances of the electrolyte and fluid balance (eg, 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 IV infusion. Should any abnormal sign occur, 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.
Kabiven/Kabiven Peripheral should be given with caution in conditions of impaired lipid metabolism, eg in renal insufficiency, uncompensated diabetes mellitus, pancreatitis, impaired liver function, hypothyroidism (with hypertriglyceridemia) and sepsis. If Kabiven/Kabiven Peripheral is given to patients with these conditions, close monitoring of serum triglyceride concentrations 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 hyperkalemia.
The amount of individual electrolytes to be added is governed by the clinical condition of the patient and by frequent monitoring of serum levels.
This emulsion is free of vitamins and trace elements. The addition of trace elements and vitamins is always required. For vitamin supplementation, pediatric formulations are recommended to be used.
Parenteral nutrition should be given with caution to patients with metabolic acidosis (eg, lactic acidosis), insufficient cellular oxygen supply, increased serum osmolarity or those in need of fluid resuscitation.
Kabiven/Kabiven Peripheral should be given with caution to patients with a tendency towards electrolyte retention.
Any sign or symptom of anaphylactic reaction (eg, fever, shivering, rash or dyspnea) should lead to immediate interruption of the infusion.
The fat content of Kabiven/Kabiven Peripheral may interfere with certain laboratory measurements (eg, 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 hrs in most patients.
IV infusion of amino acids is accompanied by increased urinary excretion of the trace elements copper and, in particular, zinc. This should be considered in the dosing of trace elements, especially during long-term IV nutrition.
In malnourished patients, initiation of parenteral nutrition can precipitate fluid shifts resulting in pulmonary edema 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 24-48 hrs, therefore careful and slow initiation of parenteral nutrition is recommended together with close monitoring and appropriate adjustments of fluid, electrolytes, minerals and vitamins.
Kabiven/Kabiven Peripheral should not be given simultaneously with blood or blood products in the same infusion set due to the risk of pseudoagglutination.
In patients with hyperglycaemia, administration of exogenous insulin might be necessary.
Kabiven Peripheral: Peripheral Infusion: As with all hypertonic solutions, thrombophlebitis may occur if peripheral veins are used for infusions. Several factors contribute to the incidence of thrombophlebitis. These include the type of cannula used and its diameter and length, the duration of infusion, pH and osmolality of infusates, infection and the number of manipulations. It is recommended that venous access sites for TPN should not be used for other IV additives or solutions.