From: Jerry Robinson Pharm.D.
To: Pharmacy Clinical Specialist, Pharmacy Residents
Cc: Berkley Stewart
Sent: Monday, March 19, 2018 2:35:29 PM
Subject: Sterile Water - Adult TPNs via CENTRAL line

Other steps to help conserve some sterile water beyond not starting or getting a TPN discontinued:

1. If starting a TPN with central line access, run the first bag at 40 mL/hr with 960 mL total volume for first day.

Recommended composition: 5% amino acids/13% Dextrose 100 mL lipid at 40 ml/hr 960 mL total volume This would be similar to starting at 3%/8% 100 mL at 60-75 mL/hr, saving around 750 mL sterile water with the first bag On second day of TPN, increase volume and rate at 8PM to calculated amount Remind nurse of the rate change on day 2

2. Run TPNs at concentrated volumes eliminating excessive sterile water use for compounding. This would potentially mean that base fluids would be continued which are also short supply items.

3. Ask MD to place central line if PPN is ordered AND TPN is necessary. [Note: Radiology can place TLC or PICC.]

Have other ideas to help conserve resources, pass them on. Thanks.

Jerry Robinson, Pharm.D., BCPS
Clinical Specialist STICU/Co-Chairperson, Medication Safety Committee Department of Pharmacy