DO YOU KNOW...

TPN steps for home use - cycled, CADD pump

 

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 might 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.

Setting-up and connecting your child to TPN

  1. 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.
  2. 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. 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.
  3. Give the TPN bag a gentle squeeze to check for leaks.
  4. Wash your hands with soap and water. See "Do you know… Clean hands."
  5. Prepare a clean workspace by wiping it with alcohol or other anti-germ cleaner.
  6. Wash your hands again.
  7. 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 nurse taught you to use. You will add multivitamins to your child’s TPN each day.
  8. Clean the injection port (rubber port) of the TPN bag with an alcohol prep pad.
  9. Inject (stick) the multivitamins into the rubber port of the TPN bag, and empty the syringe. Gently mix the contents of the bag. While you are adding the multivitamins, if the needle comes through the TPN bag, 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 TPN unless the doctor orders a skipped day.
  10. 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. Do not remove the blue clip from the cassette. 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 should receive 1200ml of TPN, the pharmacy will put 1250–1300ml in your child’s bag. When running the fluid through the tubing if you see air bubbles, run some fluid off into the garbage can or sink to remove the air. Do not remove the cap from the end of the tubing. The amount of TPN ordered will still be left.
  11. Place a new battery into pump.
  12. Pull the blue plastic clip from the cassette, and attach the 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.
  13. Check the program numbers on your child’s pump. If your child’s program has changed, the 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 to help reprogram the pump.
  14. Clamp your child’s line and carefully remove the old end cap from the 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.
  15. Flush your child’s line with 5ml of normal saline to clear the line of heparin. This also opens your child’s line to receive the TPN. 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, use the line the way you were taught by the clinical nurse specialist and the infusion nurse.
  16. Connect the TPN tubing to your child’s end cap. 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.
  17. Open any closed clamps on the TPN tubing and on your child’s line.
  18. Start the pump following the steps in "Do You Know… Using the CADD pump for TPN."
  19. Remember to loop and tape your child’s line as the line nurse taught you.
  20. Dispose of needles and syringes following the handout "Do you know… Throwing away sharp objects safely."
  21. Check your child’s urine glucose as you were taught by the clinical nurse specialist (CNS). Write down the numbers you get from the urine test and bring the results to the clinic on your next visit.
  22. 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.

Helpful hints

Remember the word SASH for cycled TPN at home:
S = Saline flush to white (small) lumen of central venous line
A = Administer (give) TPN over the number of hours ordered
S = Saline flush after the TPN has infused
H = Heparin flush

Disconnect your child from TPN

  1. Wash your hands and prepare a clean workspace. Wash your hands again.
  2. Fill a syringe with 5ml of normal saline. Fill another syringe with the amount of Heparin Lock Flush needed to flush and clamp your child’s line. The table below will tell you the type and amount of Heparin Lock Flush needed for your child’s line. Saline and heparin are both clear in color. To keep you from confusing the fluids, remember that the saline syringe will always have 5ml of fluid and the Heparin Lock Flush will never be more than 3ml. You might also place them on the table in the order that you will use them – the saline syringe closest to you.
  3. If your child has a double lumen central venous line and you do not have a clinic visit that day, you will need to put Heparin Lock Flush in the red lumen of your child’s line. If your child does have a clinic visit that requires blood samples that day, just let the clinic nurse put the Heparin Lock Flush in your child’s red lumen after the blood sample is taken.
  4. 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 and carefully remove the TPN tubing from your child’s end cap.
  5. Clean your child’s end cap well with an alcohol prep pad.
  6. Carefully apply the syringe with 5mls of normal saline to the end cap.
  7. Unclamp your child’s line. Flush it with the normal saline.
  8. Then, flush your child’s line with Heparin Lock Flush.
  9. Clamp your child’s line.
  10. Remember to loop and tape your child’s line as you were taught by your line nurse.
  11. Throw away the empty TPN bag and tubing in the regular trash.
  12. Dispose of needles and syringes following "Do you know…Throwing away sharp objects safely."

Questions?

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

Amount and type of Heparin Lock Flush needed to clush central lines.

Use this table unless the doctor, nurse, or pharmacist tells you otherwise.

Type of
central line
Double Lumen Central
Venous Line
Single Lumen Central
Venous Line
Subcutaneous
Port
PICC Line
Amount
and type of
heparin

Weight more than 3 kg
3ml of 10 unit heparin
for both lumens

Weight less than 3 kg
or 60 days old or
younger
2ml of 2 unit
preservative-free
heparin for both
lumens

Weight more than 3 kg
3ml of 10 unit heparin
for the one lumen

Weight less than 3 kg
or 60 days old or
younger
2ml of 2 unit
preservative-free
heparin for the one
lumen

3ml of 10 unit
heparin

Weight more than 3 kg
3ml of 10 unit heparin

Weight less than 3 kg
or 60 days old or
younger
2ml 2 unit
preservative-free
heparin


 

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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