Total Parental Nutrition (TPN)

Parenteral Parental Nutrition (PPN)

     If your family member has a medical condition that prevents them from absorbing nutrition through their GI tract, they may need to receive nutrition through an IV. If that is the case, they may choose to start with an IV line inserted outside the body (peripherally), and they would receive Peripheral Parenteral Nutrition (PPN) for a short term need. PPN provides all the calories someone needs through an IV administration route. However, it’s very harmful to the veins.  Most patients’ can not tolerate the high percentage of necessary dextrose or the osmolarity (thickness) required for very long. The veins are just too small to handle it. 

Total Parental Nutrition

     Therefore, due to the number of particles in total nutrition, which makes it thick and hard on the veins, Total parental nutrition (TPN) usually is administered through a large blood vessel like a subclavian vein in the neck or the superior vena cava. TPN is six times thicker than blood!  Here’s why.  It contains proteins as amino acids, carbohydrates, electrolytes, vitamins, and trace minerals.  A lipid emulsion provides fat. Dextrose 15% -25% in water is the liquid base component.  It may be necessary to add insulin to help the body with absorption. 

Sterile Technique Strictly Required

     Due to the high sugar and protein content, infection is a significant risk with TPN administration.  Therefore, following a strict sterile technique is essential at all times. Procedures below review all precautions and procedures for managing central lines in general and TPN in specifics. 

Total Parental Nutrition (TPN)

     Total Parental Nutrition (TPN) is a way to receive all of your nutrition by IV at home.

     TPN is getting all your nutrition by IV.  The IVs are delivered to your home from a Pharmacy. When working with TPN, you must always have a clean work area and hands to prevent introducing germs into the IV line that goes directly toward the heart and other major organs of the body.

     Key Points to Remember

  1. Handwashing is the MOST important part of the process for preventing infection. Don’t skip on that step. Scrub with soap and water while you hum Happy Birthday
  2. Use paper towels to cover work surfaces after you wash them with soap and water to create a second barrier of protection against germs.
  3. Keep your IVs in the refrigerator until ready for use. However, don’t give them while they are still cold.
  4. IV’s should be at room temperature when you infuse them. Take them out at least 30 minutes in advance so they can warm up. DO NOT put them in the microwave or run them under hot water to warm them up.

     The following YOUTUBE video by PruittHealth provides an overview of Total Parental Nutrition (TPN)

TPN at Home – Instructions and Overview 

TPN at Home - Pump Instructions

     Each company that provides your TPN supplies will have their own pump equipment.  Most work the same way the one in the video works, but there may be some differences. When you get a pump, it will have a tutorial associated with the pump to assist you in learning what to do.  Be sure to review it. By reviewing this video; however, you can become familiar with what to expect, the terminology used, and what it means.  Therefore, it still serves a vital learning purpose. Just remember, where there are differences between what is on this video and what you see on your pump, the details on your pump and in your manual takes priority.

TPN at Home – Pump Instructions  

TPN at Home - Monitoring your PICC Lines

Since TPN has sugar and other ingredients in it that could feed bacteria, you should know how to recognize signs of infection in an IV line.  If you develop the symptoms below, contact your doctor or pharmacist and stop the TPN promptly.  It may be contaminated.

  • Check your IV insertion site daily to confirm it looks fine.
  • Look for redness, swelling, puffiness, tenderness, pain, drainage at the site, or increased skin temperature at the site.
  • Chills, achiness, increased heart rate, fever of 100-100.5oF, overall feeling of fatigue, and illness.
YouTube Video: TPN at Home = Monitoring PICC Lines  

TPN at Home - Priming the Tubing

  • Assemble all supplies.
  • Lay down clean paper towels
  • Put on gloves
  • Open packages
  • Remove caps from extension tubing and IV port 
  • With twist motion insert extension tubing into IV port and open clamp on tubing.
  • Allow fluid to run through tubing until it fills tubing.
  • Re-clamp extension tubing.
  • Connect new tubing.
TPN at Home -Tubing Priming the Tubing 

 

TPN At home - adding multi-vitamins

  • Wash your hands and put on gloves. 
  • Identify the medications you plan to add.
  • Pop off the medicine tops and clean the rubber stoppers with an alcohol wipe.
  • Using a 10cc. syringe, pull up 5 cc of air to insert into the vial.  
  • Inject the air into the vial.  The added pressure causes the medicine to rush into the syringe. Remove the syringe.
  • Using the same syringe, pull back on the plunger to add 5 more cc of air for the next medicine vial.
  • Insert the 5 cc into the second vial. The same thing happens. Take the syringe out and carefully recap the needle.
  • One-Hand Recap Technique: A one-hand cap is done by lying the cap on the tabletop and carefully inserting the needle into the cap using one hand.
  • When ready to inject the vitamins, remove the needle cap. 
  • Using an alcohol wipe, scrub the round rubber stopper of the IV port for about 10 seconds and insert the needle through the center of the port being careful not to puncture the sides of the bag.
  • Discard the needle into a sharp’s container 
  • Mix the IV by rolling it gently between your hands. 
TPN at Home – Adding Multi Vitamins 

 

 

TPN at Home - Stopping & Disconnecting

If you need to stop your TPN for just a brief period, keep temporary caps with you. 
  • Turn your pump off (or pause it).
  • Remember to clamp both lines before disconnecting.
  • Use a red cap to attach to the tubing going to the pump.
  • Use a green cap to put on the  IV Line that is attached to your body.
  • Remember, if your short time turns longer than expected, you will need to flush with saline and Heparin.
  • If you have to be off the pump for a long time, you only have 24-hours to use a solution once it’s been opened before you must throw it out. 
TPN at Home – Stopping TPN & Disconnecting  

TPN at Home - Flushing IV Line and Attaching TPN

Steps to Flushing the IV Line to Prior to Starting TPN

  1. Gather supplies, clean area and wash hands.
  2. Set aside Heparin Flush and one Saline Flush to use after TPN is infused.
  3. Put on Gloves.
  4. Take remaining Saline Flush and push the plunger just enough to remove the air bubble. (If you removed the cap to do this, don’t let the inside of the cap touch anything or it will become contaminated). Recap the syringe if you removed cap during this process.
  5. Remove green cap from the end of IV line and discard.
  6. Scrub line 10 seconds with alcohol wipe.
  7. Remove cap of saline syringe and set aside. Attach syringe to IV line.
  8. Inject saline using push/pause technique until push complete.
  9. Leaving syringe attached to the IV line to protect the end of it while you get the TPN ready.
  10. Remove Syringe when you’re ready.
  11. Clean opening with alcohol again.
  12. Remove cap from end of tubing, insert into extension tubing with a push and a twist.
  13. Although the tubing is already in the pump, it needs to be programmed when start, how fast to run and when to stop.
TPN at Home – Flushing IV Line and Attaching TPN 

 

TPN at Home - Pump Beeping for Occulsion

Typical Reasons for Alarms

  1. Downward Occulsion:  left the clamp closed – need to release it.
  2. Other alarms sound and they show up on the screen of the monitor.  Plus, the monitor tells you what to do.
YouTube Video: TPN at Home – Pump Beeping  

 

TPN at Home - Backpack Instructions

The backpack is a travel kit that the pharmacy provides to make it easier for you to move around with TPN.  It looks like a lot of straps and pouches but each has a purpose to keep the contents safe and secure.  please use them as directed so the pump doesn’t fall out or the tubing doesn’t get kinked or pinched off as easily. 

TPN at Home – Backpack Instructions  

 

TPN at Home - Pharmacy and labs

The contents of what is added to your TPN is based on the lab work results done weekly.  The TPN should not be running when the labs are being drawn.  Stop the TPN, wait ten minutes, and then drawn the lab. 

YouTube Video: TPN at Home: Pharmacy and Labs  

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