Discharge Instructions: Total Parenteral Nutrition (TPN) for Your Child
Your child is going home on total parenteral nutrition (TPN). TPN is a way for your child to get proper nutrition through a small, soft tube called a catheter. The catheter is inserted into a vein. This allows liquid nutrition to be put directly into your child’s blood vessels. You were shown how to give your child TPN before your child was discharged from the hospital. The information below can help you remember those steps at home. The healthcare team will also schedule a home health nurse to help as needed. Always contact your healthcare team with any questions or concerns.
Always follow the instructions given by your child’s healthcare provider or home health nurse. Make sure you have these important phone numbers below:
Healthcare provider phone number: __________________________________
Home health nurse phone number: __________________________________
Medical supply company phone number: ______________________________
Central and PICC lines
There are 2 types of intravenous (IV) lines used to give TPN through a catheter:
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Central line. This kind of line is often used for infants and very young children. The catheter is placed into a vein in the neck or chest. This allows nutrients to be sent to the large blood vessels leading into the heart.
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Peripherally inserted central catheter (PICC) line. This type of line is placed into a vein in your child’s arm. The line is gently threaded through the vein up to a large blood vessel leading into the heart.
Giving your child TPN
Your child is given the TPN solution using an infusion pump. The infusion pump has settings that give your child the TPN solution in a controlled and precise manner. TPN may be given continuously or for a set time. This will depend on your child’s needs. Don't change the pump settings unless you’re instructed to do so.
Supplies
TPN supplies may include:
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Sterile gloves
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Alcohol wipes
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Saline (single-use vials)
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Heparin (single-use vials)
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Needles (may not be needed if you have blunt-end syringes)
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Syringes
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TPN bag
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IV tubing
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IV pole
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Infusion pump
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Sharps container to throw out used needles. You can buy a sharps container at a drugstore or medical supply store. You can also use an empty laundry detergent bottle or any other puncture-proof container and lid.
Steps
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Step 1. Clean your work area.
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Wash your hands with soap and water.
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Clean your work area with alcohol or a disinfectant solution. Dry with a paper towel.
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Wash your hands with soap and water again.
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Put on sterile gloves before touching any supplies.
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Step 2. Check the TPN bag.
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Check the label on the TPN bag to make sure it matches your child’s prescription.
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Check the expiration date. Don’t use the solution if it’s expired. Instead, get a new bag.
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Check the bag for problems, such as leaks, cloudiness, change in color, or floating particles. Don’t use the bag if you see any of these. Instead, get a new bag.
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Allow the TPN solution to warm up by leaving it at room temperature for 60 minutes. Don't try to warm up the bag in the microwave.
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Place the TPN bag on the clean surface in your work area.
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Step 3. Prepare the TPN bag.
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Add any additional medicines or vitamins to the bag (as you were shown in the hospital).
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Hang the TPN bag on the IV pole.
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Clamp the IV tubing.
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Connect the spiked end of the IV tubing to the TPN bag.
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Loop the IV tubing over the pole again to prevent the end from touching the floor.
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Slowly open the clamp on the IV tubing. Let a small amount of TPN solution run out the end of the tubing. This clears air out of the tubing and prevents air from entering the IV line.
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Close the clamp on the IV tubing and replace the sterile cap over the end of the tubing.
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Make sure the pump is in the STOP/OFF mode.
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Load the IV tubing into the pump.
Additional instructions: ________________________________________________________________
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When to call the healthcare provider
Call your child's healthcare provider right away if any of these happen:
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The tubing leaks or comes out
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You can't flush the tube.
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There is pain, fluid, redness, swelling, or bleeding at the catheter site
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Your child has a fever of 100.4°F (38°C) or higher, or as directed by your child's healthcare provider.
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Your child has chills.