Can Clinimix (total parenteral nutrition) be administered through a peripheral intravenous (IV) line?

From the Guidelines

Clinimix can be administered through a peripheral intravenous (IV) line, but only specific formulations with lower osmolarity are appropriate for peripheral administration. Clinimix comes in different formulations, and those with osmolarity less than 900 mOsm/L (typically labeled as Clinimix E 2.75/5,4.25/5, or 4.25/10) are suitable for peripheral IV administration 1. When using a peripheral line, the infusion site should be monitored closely for signs of phlebitis or infiltration, and the IV site should be rotated every 72-96 hours. Central venous access is preferred for higher concentration formulations, long-term TPN therapy, or when the patient requires more concentrated nutrition support. The reason for this distinction is that solutions with higher osmolarity can cause vein irritation, inflammation, and damage when administered peripherally. Peripheral administration of Clinimix should be considered a temporary solution when central access is not available or when nutritional needs can be met with lower concentration formulations.

Some key considerations for peripheral administration of Clinimix include:

• Monitoring the infusion site closely for signs of phlebitis or infiltration
• Rotating the IV site every 72-96 hours
• Using formulations with osmolarity less than 900 mOsm/L
• Limiting the duration of peripheral administration to 14 days or less
• Considering central venous access for higher concentration formulations or long-term TPN therapy

It's also important to note that the use of peripheral parenteral nutrition (PPN) can be beneficial in the perioperative setting, particularly for patients undergoing major gastrointestinal surgery who may require nutritional support 1. However, the decision to use PPN should be made on a case-by-case basis, taking into account the individual patient's nutritional needs and medical status.

From the FDA Drug Label

• CLINIMIX is for intravenous infusion only into a central or peripheral vein. The choice of a central or peripheral venous route should depend on the osmolarity of the final infusate Solutions with osmolarity of 900 mOsm/L or greater must be infused through a central catheter

o For central or peripheral vein infusion: CLINIMIX 4.25/5,6/5

Key Points:

• Clinimix can be administered through a peripheral intravenous (IV) line, but the choice of route depends on the osmolarity of the final infusate.
• Solutions with an osmolarity of 900 mOsm/L or greater must be infused through a central catheter.
• Certain formulations of Clinimix (4.25/5,6/5) can be infused through a peripheral or central vein. 2

From the Research

Administration of Clinimix through Peripheral IV Line

• Clinimix, a total parenteral nutrition (TPN) solution, can be administered through a peripheral intravenous (IV) line, but with certain considerations 3, 4, 5, 6.
• The use of peripheral IV lines for TPN administration has been shown to be a safe and effective alternative to central venous catheters, reducing the risk of complications associated with central line placement 3.
• However, the administration of TPN through peripheral IV lines requires careful consideration of the solution's osmolarity and volume to minimize the risk of phlebitis 4, 6.
• Studies have demonstrated that the use of lipid emulsions and adjustments to the nutrient solution's composition can help reduce the incidence of phlebitis when administering TPN through peripheral IV lines 4, 6.

Factors Influencing Phlebitis Risk

• The osmolarity rate, defined as the number of milliOsmols infused per hour, has been shown to correlate well with the phlebitis rate 4.
• The volume and composition of the nutrient solution, including the amount of amino acids, dextrose, and lipids, can also impact the risk of phlebitis 4, 6.
• The use of filters and the type of cannula used can also influence the risk of phlebitis 6.

Clinical Considerations

• The decision to administer Clinimix through a peripheral IV line should be based on individual patient needs and clinical status 5.
• Patients requiring short-term nutrition support (less than 10-14 days) may be suitable candidates for peripheral IV line administration of TPN 3, 6.
• Close monitoring of patients receiving TPN through peripheral IV lines is essential to minimize the risk of complications, including phlebitis and metabolic disturbances 5, 7.