A registered dietitian from your child’s primary clinic will follow her nutrition needs closely. Based on what your child eats and drinks each day, this staff member counts her daily calories and protein.
Calories are units of energy the body gets from food. The amounts of calories and protein will help the dietitian know if your child is getting enough nutrients or needs more. Nutrients are the parts of foods that are good for the body. Because the dietitian counts your child’s calories and protein, it is very important to fill out your child’s “24-Hour Intake and Output” record correctly.
If your child cannot eat or digest enough food to nourish her body and give her energy, the doctor might decide that she needs total parenteral nutrition, or TPN.
What is TPN?
TPN is a liquid given by IV (by vein). It provides nutrition for your child when she cannot eat or get enough nutrients from food. TPN gives most or all of the nutrients (fuel) your child’s body needs directly into the blood stream through a central venous line. This is an IV line placed in a central part of the body, usually the chest. Your child might have TPN until she can eat normally. The body needs 3 kinds of fuel — carbohydrates, protein, and fat.
- Carbohydrates give the body calories. This gives the body most of the energy it needs to run. The main carbohydrate source in TPN is dextrose (sugar).
- Protein is made up of amino acids. The body uses protein to build muscle, repair tissue, fight infections, and carry nutrients through the body.
- Fat is another source of calories and energy. Fat also helps carry vitamins in the blood stream. Fat supports and protects some of your organs. It also keeps your body from losing too much heat.
TPN also contains other nutrients, such as vitamins and minerals, electrolytes, and water.
- Vitamins in TPN give your child needed daily amounts of vitamins A, B, C, D, E, and K. (When you add vitamins to the TPN, the mixture turns yellow.) The body also needs minerals. These minerals are zinc, copper, chromium, manganese, and selenium. Your child needs the vitamins and minerals to grow and stay as healthy as possible.
- Electrolytes are important for bone, nerve, organ, and muscle function. These electrolytes are added to TPN: calcium, potassium, phosphorus, magnesium, sodium, chloride, and acetate.
- Water is a very important part of TPN. It helps your child get enough fluid. The amount of water in the TPN depends on your child’s height, weight, and fluid needs.
Your child might also get a medicine called ranitidine (Zantac®) in the TPN. This medicine decreases acid in the stomach. TPN goes directly into the bloodstream, so your child does not need stomach acid to help digest food. The acid can upset your child’s stomach.
Staff members will do blood tests to check your child. These tests might include a complete metabolic profile, or CMP, or a basic metabolic profile, BMP. These tests check your child’s balance of electrolytes. They also show the amounts of carbohydrate, protein, and fat in the blood. Your child’s TPN mixture might change depending on her needs and test results.
Metabolic Infusion Support Service (MISS) team
If your child cannot eat or digest enough food, the Metabolic and Infusion Support Service team, or MISS, might help care for her. The word “metabolic” means the process the body uses to break down nutrients and make energy. The MISS team includes doctors, nurses, social workers, dietitians, and pharmacists. This team is in charge of St. Jude patients who need metabolic or nutrition help. This includes patients having TPN.
The MISS team meets every week to talk about their patients. They will work closely with you and your family to prepare you for giving TPN at home if needed.
Possible problems with TPN
Your child might have problems with TPN. This can sometimes be fixed by changing the levels of protein, carbohydrates, or electrolytes in the TPN mixture. Your child’s pharmacist and registered dietitian will check all your child’s blood test results regularly and adjust the mix as needed. Hyperglycemia, or high blood sugar, is one (1) problem that can happen with TPN. It does not happen often, but you should know about it.
Hyperglycemia (high blood sugar)
Hyperglycemia is a higher than normal level of sugar in the blood. Below are some facts to know about it.
- It can happen when your child gets TPN too fast or the body cannot accept and use the sugar. Sometimes, having an infection or taking a medicine such as a steroid will make the body unable to use large amounts of sugar.
- If your child has hyperglycemia, she might have a headache or feel thirsty, weak, or sick to her stomach.
- Your child’s pharmacist and dietitian will check your child’s blood tests carefully. One (1) of those tests checks the sugar level in the blood.
How TPN starts
Your child usually starts TPN in the hospital. Some children can start without being in the hospital. To start, your child gets TPN non-stop for 24 hours. A pharmacist, registered dietitian, and your child’s doctor will decide how many calories and other nutrients your child needs each day. To avoid problems such as high blood sugar, the TPN mixture has a little more carbohydrate (dextrose) each day for several days.
When your child starts TPN, keep writing down everything your child eats or drinks every 24 hours. Use the Intake and Output record. The dietitian uses this information to count how many calories your child is taking in by mouth. This helps your child’s MISS team know how many calories she needs from TPN.
If your child is having TPN in the hospital, the staff will take a blood sample early every morning. It is important to let the nurse take your child’s blood at this time so the test results are ready when the doctor makes rounds. If your child is not staying in the hospital, she probably needs a blood test each day for several days. The blood test results tell the doctor and pharmacist how your child’s body is doing on the TPN.
Getting ready for TPN at home
If your child cannot get enough nutrition by mouth, she might need TPN after going home. Your child’s St. Jude team will consider the questions below to decide.
- Can your child eat or drink by mouth without vomiting?
- Can you or another caregiver do TPN at home?
- Do you or another caregiver want to learn how to give TPN at home?
- Can your child get medical care at home for any TPN problems?
If your child gets TPN at home, you might need to come to the Medicine Room sometimes so the team can connect or disconnect the tube. A MISS team member will talk with you about this.
You and other caregivers must learn to give TPN correctly and safely at home. Before your child receives TPN at home, you will learn the following.
- The best way to clean your hands
- How to run the ambulatory infusion pump (the machine used for giving TPN)
- How to connect and disconnect your child from the TPN
- Possible problems and how to fix them
- Who to call about TPN problems or concerns
Getting TPN supplies and help
The St. Jude staff will contact your child’s clinical nurse specialist or advanced practice nurse to arrange home TPN. The TPN comes from the St. Jude Specialty Infusion Pharmacy or an IV company. This depends on your insurance. The pharmacy or company will help make sure your child gets the best care. They will provide specially trained nurses to help teach you how to take care of your child’s TPN. These nurses are available 24 hours a day to help with problems or questions.
The pharmacy or IV company will deliver everything you need for TPN at home. This includes the pump, IV pole, backpack, and supplies. It will come to your home or the place you are staying in Memphis. A staff problems with the pump or questions.
The list below gives some of the supplies your IV company provides.
- TPN mixture
- Multivitamins and other things to add to the mixture, as needed
- Alcohol pads
- Urine dipsticks to test your child’s blood sugar
- IV medicines if your child’s doctor prescribes them
- Heparin and normal saline
- Needleless connector, called a Clave®
Continuous and cycled TPN
There are 2 ways to give TPN. They are called “continuous” and “cycled.” Continuous TPN runs all the time. Cycled TPN runs for shorter times, such as 12, 14, 16, or 20 hours.
When your child first gets TPN, it is continuous. Once your child has had TPN for some time, she might get it for shorter times. Each time is called a “cycle.” The cycle usually starts in the evening so your child can have TPN while she is sleeping. By doing this, your child’s cycle ends sometime during the day. This lets your child stop TPN for a few hours each day while she is awake. The St. Jude pharmacist sets a cycle goal for every patient. How long the cycle is depends on your child’s age, size, other medications, and health.
When your child is on continuous TPN, the pharmacist will slowly reduce the number of hours that the TPN runs each night until the best “cycle” time for your child is reached.
Sometimes your child’s TPN cannot be cycled, and your child needs continuous TPN over 24 hours. Your child’s doctor, pharmacist, and dietitian will decide if this is needed.
The clinical nurse specialist or advanced practice nurse and the infusion company nurse will teach you how to give TPN, whether it is continuous or cycled.
If you have more questions about TPN, please talk to your child’s doctor, clinical nurse specialist, pharmacist, nurse, or registered dietitian.
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.
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