What is Clinimix (total parenteral nutrition) infusion?

What is Clinimix Infusion?

Clinimix is a two-chamber bag parenteral nutrition (PN) solution containing amino acids and glucose (dextrose) combined in a single infusate, along with electrolytes as required, administered intravenously to provide nutritional support when oral or enteral feeding cannot meet patient needs. 1

Product Classification and Composition

Clinimix falls under the category of two-chamber bag or "two-in-one" PN formulations, which are industry-manufactured solutions that do not contain lipid emulsion. 1 The key components include:

• Amino acids: Crystalline amino acid solutions at varying concentrations and profiles 1
• Glucose (dextrose): Typically available in concentrations ranging from 5% to 70% w/v 1
• Electrolytes: May be included with or without basic electrolytes depending on the formulation 1
• Vitamins and trace elements: Can be added prior to administration as needed 1

The two-chamber design keeps amino acids and glucose separated until immediately before use, when the separation seals between chambers are broken to mix the substrates together. 1

Clinical Indications

Clinimix is indicated when oral or enteral routes cannot independently achieve the defined nutritional care plan target. 2 Specific clinical scenarios include:

• Total Parenteral Nutrition (TPN): When complete nutritional needs (all macro and micronutrients) must be covered intravenously with no other route of nutrition 1
• Supplemental Parenteral Nutrition (SPN): When nutrition is provided in addition to inadequate oral or enteral intake 1
• Chronic intestinal failure: Patients with malignant or partial gastrointestinal obstruction 1
• Malnourished or high-risk patients: Where full enteral nutrition feasibility is questionable 3

Administration Routes and Considerations

Central Venous Access

Central venous access is recommended for high osmolarity Clinimix formulations designed to cover nutritional needs fully. 2 This route is necessary because:

• High-concentration glucose solutions (>12.5% w/v) can cause complications with peripheral administration 1
• Central administration allows for complete nutritional provision without volume limitations 2

Peripheral Venous Access

Peripheral venous access may be used for low osmolarity mixtures designed to cover a proportion of nutritional needs. 2 However, glucose concentration should not exceed 12.5% w/v to avoid peripheral vein complications, though this threshold is patient-dependent. 1

If peripherally administered PN does not allow full provision of the patient's needs, then PN should be centrally administered. 2

Key Differences from Three-Chamber Bags

Unlike three-chamber bags (all-in-one formulations), Clinimix does not contain lipid emulsion. 1 Two-in-one PN infusates like Clinimix may be required when:

• A formulation is pharmaceutically unstable when lipid emulsion is included 1
• The clinical aim is specifically not to provide lipids 1
• Lipids will be administered separately via piggyback infusion 4

Dosing and Nutritional Targets

For adults, the recommended daily nutritional requirements are typically 25 kcal/kg/day, increasing to target over 2-3 days. 2 The gradual increase helps prevent:

• Refeeding syndrome complications 2
• Metabolic disturbances from rapid nutritional repletion 4

Safety Considerations and Common Pitfalls

Hyperglycemia Management

Hyperglycemia contributes to increased mortality in critically ill patients and should be avoided to prevent infectious complications. 2 Close monitoring of blood glucose is essential during Clinimix administration. 4

Bag Integrity

Cutting or splitting Clinimix bags that aren't designed to be divided can lead to inconsistent dosing and potential degradation of the solution. 2 Always use the bag as a complete unit unless specifically designed for division.

Infection Risk

The two-chamber system provides a relatively safe administration method with lowered infection risk due to the closed system and reduced manipulation compared to multi-bottle systems. 1 However, proper aseptic technique remains critical. 4

Storage and Preparation

Clinimix requires appropriate storage under refrigeration at 2-8°C prior to use, but should be gently warmed to room temperature before administration. 1 Vitamins and trace elements should be injected into the bag immediately prior to administration. 1

Monitoring Requirements

To prevent and mitigate potential complications, optimal monitoring is required throughout therapy, including: 4

• Blood glucose levels (to prevent hyperglycemia)
• Electrolyte balance (particularly calcium, phosphate, potassium)
• Fluid status and volume overload risk
• Catheter site for signs of infection or thrombosis
• Liver function tests with prolonged use