TRAVASOL E / TRAVASOL products are pharmacy bulk package, and not for direct infusion. The high osmolarity of these products precludes direct administration due to potential phlebitic complications (see Table 1 and Table 3). Dosing Considerations Administration of TRAVASOL E / TRAVASOL as a Component of Parental Nutrition Therapy TRAVASOL E / TRAVASOL products contain one of two sets of amino acids (Blend B or Blend C) (see Table 3) Infusion of hypertonic nutrient injections into a peripheral vein may result in vein irritation, vein damage, and thrombosis.
Since the TRAVASOL E product contains a high concentration of potassium ion (60 mmol/L, see Table 1), measures should be taken to prevent hyperkalemia when the product is to be used. Since TRAVASOL E product contains phosphate ion, addition of certain cation, especially calcium ion, into the product may result in precipitation of phosphate salts which may result in serious clinical outcomes (see Respiratory subsection WARNINGS AND PRECAUTIONS and the ADVERSE REACTIONS section).
If electrolytes are to be added to TRAVASOL product, the type and the amount of electrolytes should be dictated by the status of electrolyte balance, disease condition and related vital organ function of the patient. When used in neonates and children below 2 years, the solution (in containers and administration sets) should be protected from light exposure after admixture through administration.
Any unused portion of TRAVASOL E / TRAVASOL products should be discarded and should not be used for subsequent admixing. Page 12 of 27 Table 1. 48 g Electrolytes(1): Sodium (mmol) 70 - - Potassium (mmol) 60 - - Magnesium (mmol / mEq) 5 / 10 - - Phosphate (mmol / mEq) 30 / 60 - - Chloride (mmol) 70 40 40 Acetate (mmol) 150 87 87 Osmolarity (mOsm/L) 1305 1047 999 (1) Acetic acid glacial is added for pH adjustment Recommended Dose and Dosage Adjustment Although TRAVASOL E product contains electrolytes (Table 1), further supplementation of electrolytes may be indicated according to the clinical needs of the patient (see WARNINGS AND PRECAUTIONS | General).
Electrolyte and/or other additive supplementation for TRAVASOL product may be indicated according to the clinical needs of the patient (see see DOSAGE AND ADMINISTRATION | Additives). The total daily dose of the products depends on the patient’s metabolic requirement and clinical response.
The determination of nitrogen balance and accurate daily body weights, corrected for fluid balance, are probably the best means of assessing individual nitrogen requirements. 8 g/kg of body weight for adults. It must be recognized, however, that protein as well as caloric requirements in traumatized or malnourished patients may be increased substantially.
5 g/kg of body weight for adults and 2 to 3 g/kg of body weight for infants with adequate calories are generally sufficient to satisfy protein needs and promote positive nitrogen balance. For the initial treatment of trauma or protein calorie malnutrition, higher doses of protein with corresponding quantities of carbohydrate will be necessary to promote adequate patient response Page 13 of 27 to therapy.
The severity of the illness being treated is the primary consideration in determining proper dose level. Higher doses, especially in infants, must be accompanied by more frequent laboratory evaluation. 7 g/kg/day reduce nitrogen losses and spare body protein.
If daily increases in BUN in the range of 10 to 15 mg/dL for more than three days should occur, then protein sparing therapy should be re-evaluated. Care should be exercised to ensure the maintenance of proper levels of serum potassium.
It may be necessary to add additional quantities of this electrolyte to the solution, especially to TRAVASOL products, in order to meet the patient’s potassium intake needs. Potassium requirements in a PN formulation for generally healthy people with normal losses are 1-2 mmol/kg/day, but should be customized to meet individual patient needs.
TRAVASOL E product inherently contains potassium 60 mmol/L, and this should be taken into account prior to any supplemental potassium additions. g. renal failure). For example, 250 mL of these injections mixed with 500 mL of 70% Dextrose Injection can be administered over a 12 hour period.
Acceptable total daily administration volumes are dependent upon the fluid balance requirements of the patient. Extreme care should be given to prevent fluctuations of blood osmolarity and serum electrolyte concentrations. Frequent and careful monitoring is mandatory when fluid restricted patients are receiving intravenous nutrition.
As indicated on an individual basis, vitamins and trace elements and other components (including dextrose and lipids) can be added to the parenteral nutrition regimen to prevent deficiencies and complications from developing (see see DOSAGE AND ADMINISTRATION).
Fat emulsion coadministration should be considered when prolonged parenteral nutrition is required in order to prevent essential fatty acid deficiency (EFAD). Missed Dose In the event of a missed dose, the infusion should be restarted at the recommended dose and flow rate.
Doses should NOT be doubled. Administration Visually inspect the container. If the administration port protector is damaged, […]