Discharge Instructions: Total Parenteral Nutrition for Your Child

Your child is going home on total parenteral nutrition (TPN). TPN is a way for your child to get proper nutrition through a small, soft tube called a catheter. The catheter is inserted into a vein. This allows liquid nutrition to be put into your child’s blood vessels. You were shown how to give your child TPN before your child was discharged from the hospital. This sheet can help you remember those steps when you and your child are at home. Arrangements may also be made for a home health nurse to help you at home.

NOTE: Your child may receive TPN a different way from what is described and shown here. Always follow the instructions given by your child’s health care provider or home health nurse. Also, make sure you have the phone number for your child’s medical supply company. You’ll need to order more supplies for your child in the future. Write all of these phone numbers below.

Health care provider phone number: __________________________________

Home health nurse phone number: __________________________________

Medical supply company phone number: ______________________________

Outline of child with head turned to side showing central line inserted into vein near collarbone, and ending in heart.

A central line is inserted into a vein in your child’s neck or chest and threaded close to the heart.

Outline of child with head turned to side showing PICC line inserted into vein near elbow, and ending in heart.

A PICC line is inserted into a vein in your child’s arm and threaded up close to the heart.

Central and PICC Lines

There are two types of IV lines used to give nutrition through a catheter:

Central line: This kind of line is often used for infants and very young children. The catheter is placed into a vein in the neck or chest. This allows nutrients to be delivered to the large blood vessels leading into the heart.
Peripherally inserted central catheter (PICC) line: This type of line is placed into a vein in your child’s arm. The line is gently threaded through the vein up to one of the large blood vessels leading into the heart.

Giving Your Child TPN

Your child is given TPN using an infusion pump. Depending on your child’s needs, TPN is given continuously or for a set amount of hours throughout the day. Do not change the settings on the pump unless you’re instructed to do so.

Supplies

Sterile gloves
Alcohol wipes
Saline (single-use vials)
Heparin (single-use vials)
25-gauge needle (may not be needed if you have blunt-end syringes)
10 cc/ml syringes
TPN bag
IV tubing
IV pole
Infusion pump
Puncture-proof sharps container to dispose of used needles

Closeup of gloved hand holding catheter port while other hand cleans port with alcohol wipe.

Clean the port on the end of the catheter with an alcohol wipe.

Closeup of hand holding catheter with syringe inserted into port. Other hand is pushing down plunger of syringe to flush saline into catheter.

Flush the catheter with saline and/or heparin as instructed.

Steps

Clean your workarea.
- Wash your hands with soap and water.
- Clean your work area with alcohol. Dry with a clean cloth or paper towel.
- Wash your hands with soap and water again.
- Put on sterile gloves before touching any supplies.
Check the TPN bag.
- Check the label on the TPN bag to make sure it matches your child’s prescription.
- Check the expiration date. Don’t use the solution if it’s expired. Instead, get a new bag.
- Check the bag for problems, such as leaks, cloudiness, or floating particles. Don’t use the bag if you see any of these. Instead, get a new bag.
- Allow the TPN solution to warm up by leaving it at room temperature for 60 minutes. If you need to warm the solution quickly, put the bag in the sink and run warm (not hot) water over it. Do not try to warm up the bag in the microwave.
- Place the TPN bag on the clean surface in your work area.
Prepare the TPN bag.
- Add any additional medications or vitamins to the bag (as you were shown in the hospital).
- Hang the TPN bag on the IV pole.
- Clamp the IV tubing.
- Connect the spiked end of the IV tubing to the TPN bag.
- Loop the IV tubing over the pole again to prevent the end from touching the floor.
- Slowly open the clamp on the IV tubing. Let a small amount of TPN solution run out the end of the tubing. This clears air out of the tubing and prevents air from entering the IV line.
- Close the clamp on the IV tubing.
- Make sure the pump is in the STOP/OFF mode.
- Load the IV tubing into the pump.

Connect the TPN bag with the IV tubing to the port on the end of the catheter.

Prepare the syringe for flushing the catheter.
- If you’re using pre-filled saline or heparin syringes, skip this step and move to the next section on flushing the catheter.
- Clean the rubber top of the saline vial with an alcohol wipe.
- You may be using either a syringe with a needle or a syringe with a blunt end tip. Attach the needle or blunt end tip to the syringe at this time. Be careful not to touch the opening at the bottom of the needle, the blunt end tip, or the tip of the syringe. Remove the needle cap, if needed.
- Fill the syringe with 10 cc/ml of air for the saline flush.
- Stick the needle or blunt end tip of the syringe into the rubber top of the saline vial. Push air into the vial.
- With the needle or blunt end tip of the syringe still in the vial, turn the vial upside down.
- Pull back the plunger to withdraw 10 cc/ml of saline.
- Be sure to keep the needle or blunt end tip of the syringe below the fluid level.
- Check for air bubbles. Hold the syringe straight up and tap the barrel of the syringe. The bubbles should go to the top of the syringe. Gently, push the plunger to remove any air bubbles. Draw back if more saline is needed in the syringe.
- Put the syringe and vial down on your clean work surface.
Flushingthe catheter.
- Clean the port on the end of the catheter with an alcohol wipe.
- Remove the needle or blunt end tip at this time. Discard the needle or blunt end tip in the sharps container.
- Connect the syringe to the injection port.
- Push the plunger slowly and gently, so that the saline goes into the port. Check that there’s no resistance.
- Disconnect the syringe.
- Clean the port again with an alcohol wipe.

Connect the TPN bag to start infusion.
- Connect the IV tubing from the TPN bag to the port on the end of the catheter.
- Open the clamp on the IV tubing.
- Turn the pump to START/ON.
Disconnect the TPN bag after infusion.
- Wash your hands with soap and water. Put on a new pair of sterile gloves.
- Turn the pump to STOP/OFF.
- Disconnect the IV tubing from the port.
- Clean the port with an alcohol wipe.
- Repeat the steps above (“Prepare the syringe” and “Flush the catheter”) to prepare separate syringes with saline and heparin, and to flush the catheter.
- Discard any used syringes in the sharps container.
- Clean the port again with an alcohol wipe.
- Loop and tape your child’s catheter to the chest or arm as instructed by your child’s healthccare provider.

Additional instructions: ________________________________________________________________

___________________________________________________________________________________

Call the doctor right away if any of the following occurs:

The tubing splits or leaks or comes out partway or all the way
There is pain, drainage, redness, swelling, or bleeding at the catheter site.
- In an infant under 3 months old, a rectal temperature of 100.4°F (38.0°C) or higher
- In a child 3 to 36 months, a rectal temperature of 102°F (39.0°C) or higher
- In a child of any age who has a temperature of 103°F (39.4°C) or higher
- A fever that lasts more than 24-hours in a child under 2 years old, or for 3 days in a child 2 years or older
- Your child has had a seizure caused by the fever
Your child has shaking chills.
Your child has trouble breathing.
Your child is vomiting.
Your child’s skin or whites of eyes turn yellow (a condition called jaundice).
Your child’s hand, arm, shoulders, face, neck, back, or torso swells.
You can’t flush the tube.