From the Guidelines
Best practices for handling SMOF lipid line changes in the NICU include replacing administration sets every 24 hours to minimize bacterial contamination risk, using dedicated lines with 1.2-micron filters, and protecting lipids from light using amber tubing or light-protective covers. When handling SMOF lipid line changes, it is essential to maintain strict aseptic technique, including thorough hand hygiene, using sterile gloves, and disinfecting connection ports with appropriate antiseptics like 2% chlorhexidine in 70% alcohol 1. Key considerations for SMOF lipid line changes in the NICU include:
- Replacing administration sets every 24 hours to minimize bacterial contamination risk
- Using dedicated lines with 1.2-micron filters
- Protecting lipids from light using amber tubing or light-protective covers, especially for extremely premature infants
- Labeling lipid tubing clearly with date and time of initiation
- Following established protocols for administration rates, typically starting at 0.5-1 g/kg/day and advancing to 3 g/kg/day as tolerated
- Regular monitoring of triglyceride levels, particularly when initiating therapy or increasing doses The use of lipid emulsions enriched with omega-3-fatty acids, such as SMOF, can be beneficial in minimizing lipid peroxidation and reducing the risk of complications like bronchopulmonary dysplasia and retinopathy of prematurity in vulnerable neonates 1. It is crucial to prioritize these best practices to minimize bacterial contamination and lipid peroxidation, ensuring the safe administration of SMOF lipid emulsions in the NICU. Administration rates and lipid composition should be carefully considered, as studies have shown that the use of fish-oil based lipid emulsions can be protective in PNAC/PNALD, with a resolution of cholestasis in 76% of pediatric PNALD patients with cirrhosis 1. By following these best practices and considering the latest evidence, healthcare professionals can provide optimal care for neonates receiving SMOF lipid emulsions in the NICU.
From the Research
Best Practices for SMOF Lipid Line Changes in NICU
- Handling SMOF lipid line changes in the Neonatal Intensive Care Unit (NICU) requires careful consideration to minimize bacterial contamination and lipid peroxidation 2, 3, 4.
- The use of SMOFlipid, a multicomponent lipid emulsion, has been shown to be hepatoprotective and reduce the incidence of parenteral nutrition-associated cholestasis (PNAC) in preterm neonates 3, 4.
- To minimize lipid peroxidation, it is essential to consider the factors that influence lipid oxidation, such as the microstructure of emulsions, components from both phases, emulsifiers, pH, temperature, and light 5, 6.
Oxidation and Lipid Peroxidation
- Lipid oxidation is an inevitable event during the processing, storage, and consumption of lipid-containing products, which may cause adverse effects on both food quality and human health 5.
- The use of antioxidants and emulsifiers, as well as optimized processing parameters, packing, and storage conditions, can help limit lipid oxidation and improve the oxidative stability of lipid emulsions 5, 6.
- SMOFlipid has been shown to induce less lipid peroxidation compared to other lipid emulsions, such as soybean oil-based emulsions 2, 4.
Exposure to Light and Changing Infusion Lines
- Exposure to light can contribute to lipid oxidation, and it is essential to minimize exposure to light during the handling and storage of lipid emulsions 5, 6.
- The infusion lines should be changed regularly to prevent bacterial contamination and lipid peroxidation, and the lines should be shielded from light to minimize oxidation 2, 3, 4.
- The frequency of changing infusion lines and the use of shielding to prevent light exposure should be based on the specific guidelines and protocols established by the NICU and the manufacturer of the lipid emulsion 3, 4.