A Comparison of Outcomes for Lipid Emulsions in Total Parenteral Nutrition Among Home Infusion Patients

However, the delivery of lipids via TPN has presented certain dangers which may induce complications if not managed effectively. For instance, if a patient receives too much fat or oil-based lipid emulsion, this can lead to elevated triglyceride levels or even fat overload syndromes, such as hyperviscosity or HTGP. This risk is further compounded by the potential for hypersensitivity reactions due to many lipids' bioactive components, such as omega-3 polyunsaturated fatty acids (PUFAs), phytosterols, and the added Vitamin E. Such an overload of lipids may sound alarming; however, any potential toxicity from a TPN program can be well contained when appropriately managed. The introduction of too much fat into the diet can be detected quickly and monitored through biochemical parameters such as blood triglycerides. Hyperviscosity and its associated HTGP are most commonly seen with prolonged high doses of TPN containing large amounts of fat emulsion. It is imperative to monitor the lipid emulsion in the TPN mixture, with particular attention to the amounts taken in. One way to minimize any potential adverse effects is to slowly increase the doses of TPN over time and monitor the Total Essential Fatty Acid intake levels relative to caloric intake.   Hypersensitivity reactions due to elements within TPN mixtures are also a concern that should be closely monitored by healthcare provider personnel (Boullata et al., 2021). These occur more rarely than the more common occurrences of fat overload syndromes and have been detected in children and adults who have been administered TPN-containing PUFAs. High amounts of Vitamin E. Prompt protocols for discontinuing TPN and replacing it with another form of nutrition delivery should be swiftly enacted upon clinical observation or any suspicion of an allergic reaction or hypersensitivity response resulting from its bioactive components.   Lastly, because TPN is generally utilized for those with a compromised gastrointestinal system and those in long-term treatment, there is also an increased risk for infection from any foreign object administered intravenously through their central veins. ASEPSIS protocol should be strictly adhered to when administering TPN continuously in order to reduce any potential entry points for microorganisms into the bloodstream as much as possible, as well as performing comprehensive tests prior to each dose to determine any contamination or toxicity levels present prior to infusion (Sastry & Deepashree, 2019). The danger that may arise following the administration of lipids via TPN can be effectively managed by healthcare personnel if they are mindful of all the necessary parameters to keep in check throughout the process of administering these compounds, thus ensuring an optimal nutritional delivery system without 5 exposing patients to unnecessary danger or risk (Caro‐Bautista et al., 2021). Available Knowledge The administration of lipid emulsions as part of Total Parenteral Nutrition (TPN) is complex, requiring careful consideration of the multiple components involved in formulating an effective emulsion. Previous clinical studies have extensively explored the effects of intravenous lipids and their associated benefit in specific indications. These research studies have indicated that certain formulations of lipids, such as those with omega-3 polyunsaturated fatty acids (PUFAs), phytosterols, Vitamin E, or other antioxidants, may be particularly beneficial. Omega-3 PUFAs present in many lipid emulsions offer antioxidant benefits for the body, thus conferring a protective effect on cells from free radical damage and thus promoting the anti-inflammatory response. Omega-3 fatty acids also have cardiovascular benefits that may reduce the incidence of cardiovascular abnormalities and mortality (Djuricic & Calder, 2021). Phytosterols are plant-derived sterols commonly found in vegetable oils. They have been proposed as useful components of lipid emulsions due to their potential role in regulating inflammation and enhancing immune functions. Vitamin E is an important antioxidant, which scavenge free radicals present in lipid emulsions and provides protective effects against oxidative damage.  Selecting an adequately balanced emulsion is crucial for optimal TPN effects. Studies have shown that excessive and prolonged exposure to intravenous lipids or fat overload can disrupt normal cell physiology, causing inflammation and microvascular dysfunction in multiple organs and leading to other complications such as impaired hepatic glucose metabolism, disruption of tissue lipids, and increased morbidity. Additionally, lipid emulsions are thought to influence how some drugs are delivered and assimilated within the body and thus should be used cautiously in patients taking certain pharmaceuticals. It is also important to consider the method of administration, which can include bolus infusion, manual addition during TPN