Lipid total nutrient admixtures

PN admixtures can be prepared by mixing all components into one bag [3-in-l admixture or a total nutrient admixture (TNA)] or by mixing and infusing dextrose, amino acids, and all other components together and infusing intravenous lipid emulsion separately (2-and-l admixture). 

DF Driscoll, MN Bacon, BR Bistrian. Physicochemical stability of two types of intravenous lipid emulsion as total nutrient admixtures. J Parent Enteral Nutr 24(1) 15-22, 2000. 

IVFE 10% and 20% products can be administered by a central or peripheral vein, added directly to PN solution as a total nutrient admixture (TNA) or three-in-one system (lipids, protein, glucose, and additives), or piggybacked with a CAA and dextrose solution. IVFE 30% is approved only for TNA preparation. 

A relative wealth of information relating to the application of zeta potential to injectable emulsions has been documented with respect to the use of total nutrient admixtures (TNA). Total nutrient admixtures are prepared by mixing the lipid emulsion with other components (i.e., dextrose, amino acids, and electrolytes) in a single container prior to administration. Depending on composition, the mixtures vary widely in their stability and may show clinically unacceptable coalescence after different periods of storage time. 

C. Washington, J. A. Ferguson, and S. E. Irwin, Computational prediction of the stability of lipid emulsions in total nutrient admixtures, J. Pharm. Sci. 82, 808-812(1993). 

Driscoll DF, Silvestri AP, Bistrian BR, Mikrut BA (2007) Stability of total nutrient admixtures with lipid injectable emulsions in glass versus plastic packaging. Am J Heath-Syst Pharm 64 396-403... 

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