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Giving TPN with a Curlin® pump

 

The doctor has discharged your child, but TPN will be needed until your child is able to eat normal meals. The medical team has arranged for a home infusion pharmacy to deliver the TPN, multivitamins, other additives, tubing, and supplies to the place where you are staying.

Your child will need a new TPN bag every day. This information tells you how to prepare the bag and other information about using a Curlin pump.

Storage

Your child’s TPN and the multivitamins need to be stored on a clean refrigerator shelf or in a clean refrigerator drawer. Do not store any food in the same area as your child’s TPN. The temperature in the refrigerator should be 36 degrees F to 46 degrees F (2 degrees C to 8 degrees C). Other additives such as ranitidine, L-cysteine, or levocarnitine need to be stored at room temperature as written on the label.

Preparing to use the TPN bag

Check the TPN bag

You must get the bag ready before you attach it to your child’s pump. Follow these steps:

  • Take the TPN out of the refrigerator at least one (1) hour before you need to attach a new bag. It needs to warm up. Do not warm the TPN in the microwave.
  • Check the TPN label for the following:
    • For your child’s name and the correct medical record number, if available.
    • For the name of the TPN ordered by the doctor.
    • For the correct amount Compound volume (also known as Reservoir volume) and the Order volume (also known as Infusion volume).
    • For the amount of time the infusion will take and possible Taper-Up and Taper-Down time.
    • For the expiration date.
    • For storage instructions.
    • For leaks, squeeze the TPN bag gently to check.
    • To make sure the liquid in the TPN bag is clear – not cloudy, discolored, or specked.

If the TPN bag is leaking, damaged or the liquid in the TPN bag is cloudy, discolored, or speckled do not infuse the liquid. Throw the bag and liquid away in the regular trash and contact your home infusion nurse right away. This would be the person who gave you the medicine.

Remember that your child’s TPN bag has 50 to 100 ml more liquid than the amount on the prescription. For example, if the doctor prescribes 1200 ml of TPN over 24 hours, the pharmacy puts 1250 to 1300 ml in your child’s bag. But if the label does not look right, please call the pharmacy.

Getting ready to give TPN

  • Clean your work area with an alcohol prep pad or other disinfectant.
  • Clean your hands with soap and water and dry well, or use an alcohol-based liquid or foam hand cleaner. (See “Do you know… Clean Hands.”)
  • Then, gather these supplies and place them on the clean work area.

Supplies needed

  • Curlin pump
  • Bag of TPN
  • IV tubing
  • Multivitamins (Vial 1 and Vial 2)
    • The infusion nurse told you which multivitamins your child should receive — pediatric or adult.
  • Other additives (such as ranitidine, or L-cysteine). Check the labels for:
    • The name of the medicine on the vial,
    • The expiration date on the vial is still in the future, and
    • Storage instructions.
  • A 3, 5, or 10 ml syringe for each additive.
  • 1 syringe of sterile sodium chloride (saline for IV use). Check label for:
    • The name “0.9% Sodium Chloride Injection” on the syringe,
    • 5 mls of liquid in the syringe, and
    • An expiration date on the syringe that is still in the future.
  • 2 Site Scrubs® (If you do not have Site Scrubs, you may use 2 alcohol prep pads)
  • 3–6 alcohol prep pads for cleaning multivitamins, other additives, and injection ports
  • 2 C batteries
  • Medical tape, if needed to secure the line
  • X-span® mesh (use as a onesie if your child is a baby or T-shirt if your child is a toddler)

All supplies and IV fluids must be used only one (1) time and should be thrown away in the regular trash after use.

Preparing your child’s TPN bag

  • Clean your hands with soap and water and dry well, or use an alcohol-based liquid or foam hand cleaner. (For guidelines, see “Do you know… Clean hands.”)
  • Remove the caps from the additives and clean the tops with an alcohol prep pad for 10 seconds and let dry. You will use a new alcohol prep pad for each of the additives.
  • Remove the foil from the inject port on the TPN bag. Wipe the rubber port of the TPN bag with an alcohol prep pad for 10 seconds and let dry. Do not fan or blow on the port to dry it.
  • With the syringe and needle, withdraw the amount of vitamins that the nurse taught you to use. You will use 2 vials of multivitamins for each bag. You will add the multivitamins to your child’s TPN each day. See “Do You Know… Withdrawing Medicine from a Vial”.
  • Inject (stick) the needle for the multivitamins into the rubber port of the TPN bag and empty the syringe. Squeeze the bag gently a few times to mix the vitamins with the TPN.
  • Repeat steps for other additives such as ranitidine or L-cysteine as needed.
  • If you accidentally poke the needle through the TPN bag when you add vitamins or additives, throw the bag away. Do not use it because the bag is now dirty. Start over with a new bag if you have one, or call the pharmacy for a new bag right away. Make sure the pharmacy knows you are out of TPN. Your child should never miss a day of TPN unless the doctor says so.
  • After you inject the additives, throw away the needle and syringe in a sharps container. Follow the handout “Do You Know… Throwing Away Sharp Objects Safely.”
  • Pull the tab found at the bottom of the TPN bag, as you were shown by your infusion nurse.
  • Remove the white cap from the spike on the IV tubing. Insert the spike into the large port on the TPN bag by applying pressure and twisting back and forth. This is called spiking the bag. Be careful not to touch the spike while inserting it into the bag.
  • Lift the bag to prime (fill) the tubing with fluid. Remember that the pharmacy puts in extra TPN so you have enough to fill the tubing this way. Do not remove the “mouse ear” from the administration set.
  • If you see air bubbles in the tubing, let some TPN run into the sink to remove the air. Do not take the cap off the end of the tubing. You will still have enough TPN for your child’s needs.

Battery

If the pump is running, stop the pump, remove the old battery, clamp the tubing, and remove the old administration set.

Place a new battery in the pump daily when hanging a new bag. If the volume is greater than 1000 ml, you will need to change the battery 2 times every day – once in the morning and once when you start a new bag of TPN.

Allow the pump to complete a self-test and review.

Attaching administration set

  • Fully open the door of the pump.
  • Twist the “mouse ear” and remove it from the Flow Stop Handle (yellow).
  • Insert the blue tubing guide into its place on the right side of pump in the direction of the blue arrow. Position the tubing in front of the door hinge.
  • Center the tubing in the middle of the pumping fingers, covering the yellow dot.
  • Holding the Flow Stop Handle (yellow) insert it on an angle into its place on the left side of the pump in the direction of the yellow arrow.
  • Fully close the door of the pump and latch it securely.
  • Check the program numbers on your child’s pump. Looking at the label on the TPN bag, make any changes to the pump program as needed. Please call your home infusion company for help when making any changes.

See “Do You Know… How to Program a Curlin Pump” for more information. If you have questions about the pump program or the numbers you see, call your home infusion nurse.

Connecting the TPN

  • Put your child in a safe place where you can easily reach the central line and the TPN bag.
  • Clean your hands for 15–20 seconds with the soap and water or alcohol-based hand cleaner. Use paper towels to dry your hands. Then, use the paper towels to turn off the faucets.
  • Take off the old X-span mesh and untape the central line as needed.

1. Prepare the saline syringe

  • Remove the cap from the saline syringe as you were taught without touching the inside of the cap or the tip of the syringe. Set the cap down so the inside is facing up.
  • Holding the syringe upright, pull back on the plunger of the syringe. Look for any large air pockets, and thump out the bubbles. Slowly, push the air out of the syringe and stop when the top of the plunger is at the 5ml mark. Place the cap back on the syringe. Be careful not to touch the inside of the cap or the tip of the syringe. The saline flush can now be laid down on the table and is ready to use.
  • Disconnect tubing from the previous TPN bag or remove the disinfectant cap from the end of the Clave®.

2. Clean the Clave

  • Open 2 Site Scrubs.
  • Using a Site Scrub, scrub with a back and forth motion for 10 seconds and let dry for 5 seconds. If using an alcohol pad, wipe the end of the Clave 8 seconds on the top and 8 seconds around the rim in the grooves and let dry for 15 seconds.
  • Do not blow on or fan the Clave.
  • After the Clave is clean, do not lay it down.

3. Flush the line with saline

  • With your free hand, pick up the saline syringe and remove the cap as you were taught without laying down the Clave.
  • Attach the saline syringe to the Clave. Unclamp the central line, and flush with saline with a pulsing motion as you were taught. Re-clamp the line. Then, remove the syringe.

4. Clean the Clave again

  • Using a Site Scrub, scrub with a back and forth motion for 10 seconds and let dry for 5 seconds. If using an alcohol pad, wipe the end of the Clave 8 seconds on the top and 8 seconds around the rim in the grooves and let dry for 15 seconds.
  • Do not blow on or fan the Clave.
  • After the Clave is clean, do not lay it down.

5. Start the infusion

  • Remove the cap from the end of the TPN tubing and connect to the cleaned Clave.
  • Unclamp the TPN tubing and unclamp the central line to start giving your child the TPN. It will start going into your child’s line as soon as the pump is running.
  • Start the pump following the steps in “Do You Know… How to Program a Curlin Pump.”
  • Place the TPN bag and Curlin pump in a backpack.
  • Throw away needles and syringes in the sharps container you received from the home infusion company. See “Do You Know… Throwing Away Sharp Objects Safely.”
  • All other supplies and TPN are a onetime use and must be thrown away in the regular trash.

6. Check urine for glucose

Check your child’s urine glucose as you were taught by the home infusion nurse. See “Do You Know… How to Check Urine for Glucose and Ketones.” Write down the numbers you get from the urine test and bring the results to the clinic on your next visit.

Medicine side effects

All medicines, including TPN, have side effects. Some are mild and some are more severe. Please refer to the Patient Medication sheets you received when your child’s medicines were first delivered. If you have questions or concerns that your child might be having an allergic reaction, stop the infusion and call the Medicine Room at 901-595-2441.

Call 911 if your child has a medical emergency and needs help right away.

Disconnecting your child from TPN

  • Put your child in a safe place where you can easily reach the central line and the TPN bag.
  • Clean your work area with an alcohol prep pad or other disinfectant.
  • Clean your hands with soap and water and dry well, or use an alcohol-based liquid or foam hand cleaner. See “Do You Know… Clean Hands.”
  • Then, gather your supplies and place them on your clean work area.

Supplies needed

  • 1 syringe of sterile sodium chloride (saline for IV use). Check label for:
    • The name “0.9% Sodium Chloride Injection” on the syringe,
    • 5 mls of liquid in the syringe, and
    • An expiration date on the syringe that is still in the future.
  • 1 syringe of heparin 10 units/ml for IV use. Check label for:
    • The name “Heparin Lock Flush 10 USP units/ml” on the syringe,
    • 3 mls of liquid in the syringe, and
    • An expiration date on the syringe that is still in the future.
  • 1 disinfectant cap
  • 3 Site Scrubs (If you do not have Site Scrubs, you may use 3 alcohol prep pads)
  • X-span® mesh (use as a onesie if your child is a baby or T-shirt if your child is a toddler)
  • Medical tape, if needed to secure the line

1. Prepare the saline syringe

  • Remove the cap from the saline syringe as you were taught without touching the inside of the cap or the tip of the syringe. Set the cap down so the inside is facing up.
  • Holding the syringe upright, pull back on the plunger of the syringe. Look for any large air pockets, and thump out the bubbles. Slowly, push the air out of the syringe and stop when the top of the plunger is at the 5ml mark. Place the cap back on the syringe. Be careful not to touch the inside of the cap or the tip of the syringe. The saline syringe can now be laid down on the table. It is ready to use.

2. Prepare the heparin syringe

  • Remove the cap from the heparin syringe as you were taught without touching the inside of the cap or the tip of the syringe. Set the cap down so the inside is facing up.
  • Holding the syringe upright, pull back on the plunger of the syringe. Look for any large air pockets, and thump out the bubbles. Slowly, push the air out of the syringe and stop when the top of the plunger is at the 3ml mark. Place the cap back on the syringe, being careful not to touch the inside of the cap or the tip of the syringe. The heparin syringe can now be laid down on the table. It is ready to use.

Ending the Infusion

When the Infusion Volume has been given, the pump will change to a KVO rate. Remember that your child’s TPN bag has 50 to 100 ml more liquid than the amount on the prescription, so the TPN bag will not be empty.

  • Open 3 Site Scrubs and place them on the clean work area.
  • Press Pause on the pump. The screen will read “Resume, Repeat Rx, New Program.”
  • Close the clamp on the TPN tubing.
  • Clamp your child’s central line.
  • Clean your hands with soap and water and dry well, or use an alcohol-based liquid or foam hand cleaner.
  • Remove the TPN tubing from the Clave on your child’s line.

1. Clean the Clave

  • Using a Site Scrub, scrub with a back and forth motion for 10 seconds and let dry for 5 seconds. If using an alcohol pad, wipe the end of the Clave 8 seconds on the top and 8 seconds around the rim in the grooves and let dry for 15 seconds.
  • Do not blow on or fan the Clave.
  • After the Clave is clean, do not lay it down.

2. Flush the line

  • With your free hand, pick up the saline syringe and remove the cap as you were taught without laying down the Clave.
  • Attach the saline syringe to the Clave. Unclamp the central line, and flush with saline with a pulsing motion as you were taught.
  • Clamp the line. Remove the saline syringe.

3. Clean the Clave again

  • Using a Site Scrub, scrub with a back and forth motion for 10 seconds and let dry for 5 seconds. If using an alcohol pad, wipe the end of the Clave 8 seconds on the top and 8 seconds around the rim in the grooves and let dry for 15 seconds.
  • Do not blow on or fan the Clave.
  • After the Clave is clean, do not lay it down.

If your child is receiving TPN over 24 hours, you will connect the new TPN bag to your child’s line at this time.

If your child is receiving TPN over 23 hours or less you will flush the line with heparin because your child will be disconnected for an extended period of time.

4. Flush with heparin

  • With your free hand, pick up the heparin syringe and remove the cap as you were taught without laying down the Clave.
  • Attach the syringe to the Clave. Unclamp the central line, and flush the line with most of the heparin. When the plunger reaches the 1ml mark on the syringe, do a steady push to finish the flush, while holding pressure on the plunger, clamp the central line. This helps keep the line open and free from blood.
  • Remove the heparin syringe.

5. Clean the Clave again

  • Using a Site Scrub, scrub with a back and forth motion for 10 seconds and let dry for 5 seconds. If using an alcohol pad, wipe the end of the Clave 8 seconds on the top and 8 seconds around the rim in the grooves and let dry for 15 seconds.
  • Do not blow on or fan the Clave.
  • After the Clave is clean, do not lay it down.

6. Cap the line

  • Remove the cover from the disinfectant cap and attach the cap to the Clave. Alcohol will spill from the cap and your hand may get wet when you attach the cap to the Clave. This is OK. You may now lay down the line.
  • Loop the line, and put on X-span mesh if your child is an infant or toddler.
  • Throw the empty TPN bag and syringes into the regular trash.
  • Clean your hands again.

Problems and troubleshooting

Stop the infusion and call the Medicine Room or your home infusion nurse right away if:

  • The TPN or tubing begins to leak during the infusion;
  • The infusion stops before the ordered infusion volume is given;
  • The IV site becomes red or swollen; or
  • You see leaking or drainage from the IV site.

Questions?

If you have questions about giving TPN with a Curlin pump, please call your child’s home infusion nurse. If you are using the St. Jude Home Infusion Service, call 901-595-7464. If you are outside the Memphis area, you can dial toll-free 855-466-3799. You may also call your child’s doctor, nurse, or pharmacist. In the local area, call 901-595-3300. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833).


 

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).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-278-5833 (TTY: 1-901-595-1040).

تنبيه: إذا كنت تتحدث باللغة العربية فيمكنك الاستعانة بخدمات المساعدة اللغوية المتوفرة لك مجانا. .يرجى الاتصال بالرقم. 5833-278-866-1  (الهاتف النصي: 1040-595-901-1).