It's in the Bag (Packaging)
What type of plastic is the CLIMIMIX bag?
CLARITY plastic bag
BONUS:
* Does CLARITY contain DEHP? What is DEHP and why is it important?
* What is PVC and what plasticizer is added when the plastic is used for IV bags?
* What Baxter proprietary bags have PVC?
* What Baxter nutrition products are packaged in PVC plastic bags?
What is EVA and describe its characteristics?
What Baxter nutrition products are made with EVA?
Name any of the CLINIMIX formulations with higher protein.
BONUS: What is the highest protein concentration of CLINIMIX available?
Bonus:
Highest protein concentration: 8 g / 100 mL
(80 g / L)
What does IC stand for and what is it?
IC = Indirect calorimetry
Comparing still patient's inhaled and exhaled gas content to measure resting energy expenditure (REE)
Used to determine energy and protein targets.
Bonus:
is it beneficial to take IC measurements throughout the course of a patient's therapy? Why?
What 3 packaging / storage features are used to improve INFUVITE stability and shelf life?
* Two vial system
* Amber bottles
* Refrigerated storage
Bonus
* How many doses in a bulk vial system?
(When 2 vials are combined)
* What are the two formulations and how do their indications differ?
For the CLINIMIX 4.25/10 Injection product,
1) What does the number “4.25” represent?
2) What does the number "10" represent?
1) 4.25 = Final concentration of amino acids after activation
2) 10 = Final concentration of dextrose after activation
What is the most common way clinicians determine energy needs?
List 2 benefits of this method.
List 1 drawback of this method.
Predictive Equations
Benefits
- Cost
- No equipment needed
Drawbacks
- Lack accuracy (Can be inaccurate in up to 50% of critically-ill patients)
-
How is packaging aluminum content disclosed to customers?
* Al statement in package insert:
- For SVP - Content at expiration
- For LVP - Not to exceed 25 micrograms / liter (mcg / L)
Bonus
* Why is aluminum content measured at product expiration?
* Name 3 other facts that can be found in the PI?
* Are all products versions listed in the PI available for purchase? Why or why not?
Describe the difference:
- Between the CLINIMIX bag designs
- When adding lipids to 2-port and 3-port CMX containers
2-port container does not have large-bore additive port
Both containers have a:
- Administration port
- Additive port that accepts a needle
CMX 2-port lipid addition: Use a transfer set with a 19-22 gauge needle at one end and spike on the other using gravity. It should not spill when the set is removed.
CMX 3-port lipid addition: Use a large bore transfer set with spikes at each end and use gravity to transfer the lipid emulsion, then seal the port with a clamp to prevent spillage when you remove the set.
Bonus:
* List other differences between the 2-port and 3-port CLINIMIX bags
(100 Points each)
What are 4 Q-NRG+ features?
* Speed of collecting measurements
* Intuitive, user-friendly
* Mobile, portable
* Point of care (POC), flexibility for various care settings
Explain how CLINIMIX / CLIMIMIX E prevents Calcium Phosphate precipitate from forming prior to activation.
The Calcium and Phosphate components are separated to prevent the formation of precipitates during storage.
Calcium is in the Dextrose chamber to separate it from Phosphate in the Amino Acid chamber
Bonus
How does the EXACTAMIX compounder reduce the risk of forming CaPO4 precipitates?
Describe the dating for CLINIMIX for the container:
(1) In the overwrap
(2) Removed from the overwrap, not activated and refrigerated
(3) Removed from the overwrap, activated and refrigerated,
(4) After activating and adding IV fat emulsion
Expiration Dating
(1) In the overwrap = 2 years (expiration date)
Beyond Use Dating (BUD)
(2) Removed from the overwrap, not activated, and refrigerated = 9 days
(3) Removed from the overwrap, activated, and refrigerated = 9 days
(4) After activating and adding IV fat emulsion = Under refrigeration and limited to a brief period, no longer than 24 hours
What are 3 methods to collect measurements using Q-NRG+?
* Via a mechanical ventilator
* Via a canopy
* Via a face mask
Bonus:
* Which methods are used for spontaneously breathing patients?
Describe the OXYDETECT inside CLINOLIPID overwrap.
- Uses
- Physical description
* Indicates if product has been exposed to oxygen
* Physical description:
- A color changing indicator
- A color legend:
> Mustard yellow color is ok to use
> Black color should not be used
Bonus
* In addition to the product what else is inside the CLINOLIPID overwrap?
* What product has an OXALERT indicator and what company makes the product?
1) What are 3 appropriate messages regarding CLINIMIX formulations with higher protein?
2) Who are 2 good targets for CLINIMIX with higher protein?
* We offer the highest amount of protein per liter.
* Increased protein concentration provides more amino acids with less fluid for fluid restricted patients.
* Increased protein concentrations can provide the same amount of protein with less dextrose for patients who need to limit the amount of carbohydrates.
* Baxter offers Nutrition care as unique as your patient.
* Premix PN formulations that reduce the risk of touch contamination compared to admixing.
* Studies have shown critically-ill patients that receive higher protein doses can have increased wound healing, reduced days on mechanical ventilators, improved mortality, decreased length of stay, and reduced muscle wasting.
Note: 2022 American Society of Enteral and Parenteral Nutrition (ASPEN) guidelines do not support improved clinical outcomes based on higher protein intake. Recommendation says clinical evidence is weak.
Targets for CLINIMIX with higher protein:
* Existing CLINIMIX customers
* Customers with standard PN formulations integrated into their order forms / templates
* KABIVEN / PERIKABIVEN customers
* Potential patient demographics including congestive heart failure, renal failure, edema or swelling
Bonus:
* What vendor makes KABIVEN?
* What is the difference between KABIVEN and PERIKABIVEN?
* Describe the KABIVEN / PERIKABIVN container.
What are the 4 steps in the clinician's indirect calorimetry workflow?
* Access - By getting IC measurement
* Prescribe - Use results to guide therapy
* Deliver - Administer appropriate nutritional therapy
* Monitor - Ensure that patient receives optimal nutrition
Bonus:
List 3 methods of giving nutritional therapy.