Clinical experience with fat-containing TPN solutions

Abstract

The administration of fat to patients receiving TPN is now gaining popularity in the United States but it has been routine in some European countries since a safe fat emulsion became available in the early sixties. Fat has been given to lower the osmolarity of TPN mixtures making possible their administration through peripheral veins^1,2 or, in weekly infusions, to prevent essential fatty acid deficiency. Solassol and Joyeux³ from Montpellier introduced the concept of ‘mélange nutritif’ (nutritional mixture) in 1972. They advanced the idea that TPN solutions should be as complete and physiological as possible and suggested that all the basic nutrients could be delivered simultaneously after being mixed in a single container. They showed convincingly that fat emulsions could be incorporated into solutions containing glucose, amino acids, electrolytes and vitamins and that the resultant mixture was stable at 4 °C. A silicone U-shaped bag was designed by these authors in which all the nutrients were mixed and then infused through a central venous catheter over 12–24 h^3–5. These bags have now been replaced by plastic disposable containers.