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Giving lipids at home – cycled, CADD pump

 

Your child is receiving TPN (total parenteral nutrition) at home until he can eat normal meals. Lipids are another source of calories used to increase or maintain your child’s weight. Your doctor has ordered lipids added to your child’s TPN infusion.

A separate CADD pump may be used to give the lipids. This pump will be connected to your child’s TPN pump using a Y connector. This allows the TPN and lipids to infuse at the same time through one lumen of your child’s central venous line.

The lipids will be delivered to you by the same courier that delivers your child’s TPN. Store the lipids at room temperature.

Preparing the lipids will be another step in the process you have already learned for preparing your child’s TPN. You will follow the same steps for preparing the space and washing hands as you were taught for giving TPN. Refer to TPN Steps for Home Use to review these.

Y connector

Y connector

Bag of lipids

Bag of lipids

Supplies

  • 1 bag of lipids
  • Infusion set (IV tubing)
  • CADD pump (labeled for lipids)
  • 9 volt battery
  • Bifuse Y connector
  • Clave®

Preparing lipid infusion

  1. Lipids are prepackaged in a plastic wrapper. The pharmacy label for your child’s lipids will be stapled to the plastic wrapper. Open the wrapper and remove the bag of lipids. Apply the pharmacy label to the lipid bag. Having the label on the bag is important in case of an emergency so that medical personnel would know what had been ordered by the doctor.
  2. Prepare your child’s TPN bag as previously instructed. Open the Y connector and attach the IV tubing to the side with the blue clamp on it. Prime the tubing as instructed for TPN.
  3. Open the IV tubing and connect to the side of the Y connector that has the yellow ring.
  4. Turn the lipid bag upside down so all the air rises to the top. Spike down into the bag (top photo at right) and then squeeze all the air from the bag (second photo at right).
  5. Once the air is squeezed out, turn the bag over and allow the tubing to prime by gravity.
  6. When priming is complete, close the clamp on the IV tubing.
  7. The CADD pump will be in continuous mode indicated by “CON” on the screen for lipid infusion. Review the program to make sure the volume and rate match the label that was provided by the pharmacy.
  8. Attach the cassette to the pump.
  9. Once both infusions are prepared and all tubings are primed, change the Clave® as you have been taught and flush your child’s line with saline. Then, connect the end of the Y connector to the new Clave® on your child’s line. See third photo at right.
  10. Start the TPN infusion first and then the lipid infusion. Check to be sure you have opened all of the clamps on the IV tubing, the Y connector and your child’s line.
  11. When the lipid infusion is finished, your child may still have TPN to receive. You will need to remove the lipid bag and tubing. To do this, you must stop both infusions. Remove the Y connector from your child’s line and disconnect the TPN from the Y connector.
  12. Clean the Clave®, and then attach the TPN tubing to the Clave® on your child’s line and restart the TPN infusion. You do not need to flush with saline at this time.
  13. There may be fluid remaining in the lipid bag. You may throw away any leftover fluid along with the tubing in the regular trash.
Lipid bag
Lipid bag
Lipid bag connectors
  1. Once the air is squeezed out, turn the bag over and allow the tubing to prime by gravity.
  2. When priming is complete, close the clamp on the IV tubing.
  3. The CADD pump will be in continuous mode indicated by “CON” on the screen for lipid infusion. Review the program to make sure the volume and rate match the label that was provided by the pharmacy.
  4. Attach the cassette to the pump.
  5. Once both infusions are prepared and all tubings are primed, change the Clave® as you have been taught and flush your child’s line with saline. Then, connect the end of the Y connector to the new Clave® on your child’s line. See photo at right.
  6. Start the TPN infusion first and then the lipid infusion. Check to be sure you have opened all of the clamps on the IV tubing, the Y connector and your child’s line.
  7. When the lipid infusion is finished, your child may still have TPN to receive. You will need to remove the lipid bag and tubing. To do this, you must stop both infusions. Remove the Y connector from your child’s line and disconnect the TPN from the Y connector.
  8. Clean the Clave®, and then attach the TPN tubing to the Clave® on your child’s line and restart the TPN infusion. You do not need to flush with saline at this time.
  9. There may be fluid remaining in the lipid bag. You may throw away any leftover fluid along with the tubing in the regular trash.

Questions?

If you have questions about this process for giving lipids at home using the CADD pump, please talk to your child’s home infusion nurse.


 

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).

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