The doctor has discharged your child, but she still needs TPN until she is able to eat normal meals. Your child’s medical team has arranged for an IV infusion pharmacy to deliver the TPN, multivitamins, tubing, and other supplies to the place where you are staying. The pharmacy may deliver enough TPN and supplies for several days. Put the TPN, multivitamins, and batteries in the refrigerator. Place them either on a clean shelf or in a clean drawer. Do not store any food items on the same shelf or in the same drawer as the TPN.
For continuous TPN, you will usually prepare a new bag every evening before bedtime.
- Your child’s TPN should already be hooked up and running since it is continuous (nonstop) and will run 24 hours every day. If your child has a double lumen central venous line, the TPN should be running through the white lumen.
- Take the TPN out of the refrigerator at least one (1) hour before hook-up to warm it to room temperature. Do not warm the TPN under hot water or in the microwave.
- Check the TPN label for your child’s name. Also, check the label for the correct amount and the correct time that the TPN will run. Since your child is on continuous TPN, the label should say to give it over 24 hours. Remember that your child’s TPN bag will contain an "overfill" of 50–100ml. If the label does not seem right, please call your IV infusion pharmacy.
- Give the TPN bag a gentle squeeze to check for leaks.
- Wash your hands with soap and water. See "Do you know… Clean hands."
- Prepare a clean workspace by wiping it with alcohol or other anti-germ cleaner.
- Wash your hands again.
- The clinical nurse specialist or the infusion nurse told you which multivitamins your child should receive — pediatric or adult. Be sure you have the correct multivitamins by checking the label on the bottles. With a syringe and needle withdraw the amount of vitamins that the nurses taught you to use. You will add multivitamins to your child’s TPN each day.
- Clean the injection port (rubber port) of the TPN bag with an alcohol prep pad.
- Inject (stick) the multivitamins into the rubber port of the TPN bag, and empty the syringe. Gently mix the contents of the bag. If the needle comes through the TPN bag while you are adding the multivitamins, the TPN is contaminated (dirty). Do not use this bag of TPN. Start over with a new bag if you have one, or call your IV infusion pharmacy to deliver a new bag. Your child should never miss a day of her TPN unless the doctor orders a skipped day.
- Insert the tubing into the end of the TPN bag. This is called spiking the bag. Prime (fill) the tubing by running TPN through it. The pharmacy will add extra TPN to your child’s bag so there will be plenty to prime the tubing. For example, if your child is to receive 1200ml of TPN over 24 hours, the pharmacy will put 1250-1300ml in your child’s TPN bag. If you see air bubbles when running the fluid through the tubing, run some fluid off into the sink or garbage to remove the air. The amount of TPN ordered will still be left.
- Fill a syringe with 5ml of normal saline.
- When the program gets close to being finished, the pump will beep, both lights above the screen will start to blink and the screen will read "Reservoir Volume Low." When the pump beeps six times in a row, the "Infusion Volume" has been given, but the bag will not be empty. The screen will then change to say "Running" with the letter "K" behind it along with "Res Vol" and "Press Next to Advance." The pump is now in "Keep Vein Open" mode.
- Clamp your child’s line. Disconnect the TPN tubing from your child’s line.
- Place a new battery into the pump.
- Remove the old cassette from the pump. Pull the blue plastic clip from the new cassette and attach the new cassette to the pump as instructed by the infusion nurse. See "Do You Know… Giving IV fluids at home" for step-by-step details on loading the cassette, removing the cassette, and troubleshooting.
- Check the program numbers on your child’s pump. If your child’s program has been changed, your child’s infusion pharmacy will call you by telephone and leave a message asking you to call the nurse. The nurse will help you reprogram (change the numbers in) your child’s pump by telephone. If you feel uneasy about this, the infusion nurse will come to you in person to help reprogram the pump.
- Carefully remove the old end cap from your child’s line. Clean the end of your child’s line well with an alcohol prep pad. Carefully apply a new end cap to the end of your child’s line.
- Flush your child’s line with the 5ml of normal saline. If your child has a double lumen central venous line, you will connect the TPN to the white lumen. If your child has a single lumen central venous line, a subcutaneous port, or a PICC line, flush the line.
- Connect the TPN tubing to the end cap on your child’s line. You should keep the end of the tubing as clean as you can. If you touch the open end of the tubing, clean it for seven seconds with an alcohol prep pad and connect it to your child’s end cap. Open any closed clamps on the TPN tubing and on your child’s line.
- Start the pump following the steps in "Do You Know… Using the CADD pump for TPN."
- Remember to loop and tape your child’s line as the line nurse taught you.
- Dispose of your child’s needles and syringes following the "Do you know… Throwing away sharp objects safely."
- Throw away the empty TPN bag and tubing in the regular trash.
- Check your child’s urine glucose as you were taught by the clinical nurse specialist. Write down the numbers you get from the urine test and bring the results to the clinic on your next visit.
- Remember to pick up a new urinal or hat from the outpatient clinic every 2 days. Throw away the old one in your regular trash.
Remember the letters SAS for continuous TPN at home:
S = Saline flush to white (small) lumen of central venous line
A = Administer (give) TPN over 24 hrs, as ordered
S = Saline flush after the TPN has infused
Note: No heparin is used in the white lumen while TPN is infusing over 24 hours.
If you have questions about this process for giving continuous TPN at home using the CADD pump, please talk to your child’s home infusion nurse or line care 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.
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