Clinimix Infusion Rate Guidelines
The recommended infusion rate for Clinimix (total parenteral nutrition) should follow a gradual tapering approach, with a maximum rate of 24 hours per bag and a reduced rate during the final 30 minutes of infusion to prevent rebound hypoglycemia. 1
Adult Infusion Rate Guidelines
Clinimix administration should follow these key principles:
- The hanging time for a Clinimix admixture should be no longer than 24 hours 1
- At the end of cyclic PN administration, the infusion rate should be reduced to avoid rebound hypoglycemia (e.g., half of the infusion rate over the last half an hour) 1
- Maximum glucose administration rate should not exceed 5-7 mg/kg/min (corresponding to approximately 350g glucose over 12 hours in a 70kg adult) 1
Pediatric Infusion Rate Guidelines
For pediatric patients, Clinimix infusion rates are based on the FDA-approved dosing guidelines that account for age and weight 2:
Preterm and Term Infants Less than 1 Month
- Infusion rate range: 1.6-3.9 mL/kg/hr (depending on formulation)
- Provides 3-4 g/kg/day of protein
Infants 1 Month to Less than 1 Year
- Infusion rate range: 1.0-2.9 mL/kg/hr (depending on formulation)
- Provides 2-3 g/kg/day of protein
Children 1 Year to Less than 11 Years
- Infusion rate range: 0.5-2.0 mL/kg/hr (depending on formulation)
- Provides 1-2 g/kg/day of protein
Adolescents 11 Years to 17 Years
- Infusion rate range: 0.4-1.5 mL/kg/hr (depending on formulation)
- Provides 0.8-1.5 g/kg/day of protein
Practical Administration Guidelines
Initiation and Advancement
For continuous feedings, a gradual approach is recommended 1:
- Start at a lower rate and gradually increase
- For adults, typically begin at 40-60 mL/hr and increase by 10-20 mL/hr every 8 hours until target rate is reached
- For children, follow the age-appropriate guidelines in Table 38 of the KDOQI guidelines 1
Discontinuation
To reduce the risk of hypoglycemia after discontinuation, a gradual decrease in flow rate in the last hour of infusion should be implemented 2, 1:
- Reduce to half the infusion rate during the final 30 minutes
- This helps prevent rebound hypoglycemia by allowing the body to adjust to decreasing glucose levels
Monitoring During Infusion
Regular monitoring is essential during Clinimix administration:
- Monitor blood glucose levels regularly, especially during initiation and rate changes
- For stable patients on long-term home parenteral nutrition (HPN), check body weight, hydration status, electrolytes, and biochemistry every three to six months 1
- Annual evaluation of vitamin and trace element status is recommended for long-term HPN patients 1
Special Considerations
Lipid Administration
When lipids are administered with Clinimix:
- Lipid emulsions can be safely administered at a rate of 0.7-1.5 g/kg over 12-24 hours 1
- Avoid hypertriglyceridemia by maintaining triglyceride values below 12 mmol/L 1
Home Parenteral Nutrition
For patients receiving Clinimix at home:
- Cold chain must be guaranteed during transport and storage 1
- The giving set should be changed with each new PN dose 1
- Regular monitoring and follow-up by a nutrition support team is essential 1
Common Pitfalls to Avoid
- Rapid infusion rates: Can lead to metabolic complications including hyperglycemia, electrolyte imbalances, and fluid overload
- Abrupt discontinuation: Can cause rebound hypoglycemia; always taper the infusion
- Inadequate monitoring: Regular assessment of metabolic parameters is essential
- Exceeding hanging time: Never exceed 24 hours for a single bag to minimize infection risk
- Improper storage: Maintain cold chain for customized formulations
By following these guidelines, clinicians can optimize the safety and efficacy of Clinimix administration while minimizing the risk of complications.