Discharge Instructions: Flushing Your Total Parenteral Nutrition (TPN) Catheter

You are going home on total parenteral nutrition (TPN). This is a way for you to get nutrition through a tube (called a catheter) in your vein. The TPN solution contains the vitamins, minerals, and energy that you normally get by eating food. Your doctor will decide whether or not you can also eat while you are on TPN.

You will need to keep your catheter from clogging. This is done by flushing the catheter with saline solution. Depending on the type of catheter you have, you may also need to flush your catheter with a drug called heparin after the saline flush.

You will work closely with a nurse until you feel comfortable taking care of your catheter and giving yourself TPN.

This sheet describes the procedure to flush your catheter. It contains reminders and pointers about what you’ll need to do each day. Ask your doctor or nurse for more information about caring for your catheter, using sterile technique, and adding medications to your solution. There are additional sheets available to guide you.

Home Care

Find out whether your catheter is open- or closed-ended.

• Open-ended catheters must be flushed with saline before starting TPN. They must be flushed with heparin and saline after stopping TPN.

• Closed-ended catheters must be flushed with saline before and after TPN.

Wash Your Hands

Wash your hands before touching any of your supplies:

• Turn on the water.

• Wet your hands and wrists.

• Use liquid soap from a pump dispenser. Work up a lather.

• Scrub your hands thoroughly.

• Rinse your hands with your fingers pointing toward the drain.

• Dry your hands with a clean cloth or paper towel. Use this towel to turn off the faucet.

• Remember, once you have washed your hands, don’t touch anything other than your supplies. You must wash your hands again if you touch anything else such as furniture or your clothes.

Gather Your Supplies

Here's what you'll need:

• For a saline flush:

  • 25-gauge needle and 10 ml syringe

  • 10 ml bottle of saline

  • Povidone-iodine swabs sticks

  • Alcohol pads

• For a heparin flush (if needed):

  • Heparin in the amount prescribed

  • 25-gauge needle and 10 ml syringe

  • Povidone-iodine swab sticks

  • Alcohol pads

• Trash can

• Puncture-proof container to dispose of used needle and syringe (large glass jar that has a lid).

Clean Your Work Area

• Shut pets and children out of your work area.

• Clean washable surfaces with soap and water, and dry with a clean cloth or paper towel.

• Wipe surfaces that are not washable (such as fabric or wood) so that they are free of dust.  Spread a clean cloth or paper towel over your work surface.

• Place your supplies on the cleaned and dried work surface.

• Wash your hands again, using the steps for handwashing listed above.

• If you ever need to cough or sneeze, move away from your work surface.

Prepare the Syringe(s):

• Wipe the rubber top of the saline vial with an alcohol pad.

• Attach the needle to the syringe, being careful not to touch the opening at the bottom of the needle (hub) or tip of the syringe.

• Remove the needle cap.

• Fill the syringe with 10 ml of air for the saline flush.

  • If you are also using heparin, get a second syringe.

  • Fill the second syringe with air equal to the amount of heparin prescribed for your flush.

• Stick the needle into the rubber top of the saline vial. Push air into the vial.

• With the needle still in the vial, turn the vial upside down.

• Pull back on the plunger to withdraw 10 ml of saline.

• Be sure to keep the needle below the fluid level.

• Check for air bubbles. Hold the syringe straight up and tap the barrel of the syringe with your knuckles. The bubbles should go to the top of the syringe.

• Push out any air and extra fluid. The black line of the rubber piece attached to the plunger should be on the line next to the number 10 (ml) for saline.

• Take the needle out of the vial.

• If also using heparin, repeat the above process using the second syringe and filling it with the prescribed amount of heparin. Be sure to check for air bubbles.

• Put the cap back on the needle.

• Be careful. Don't stick yourself.

• Put the syringe down.

Flush the Catheter

• Clean the injection cap on your catheter with a povidone-iodine swab. Let it dry completely. Follow with the alcohol swab. Again, let it dry completely.

• Attach the syringe to the injection port as shown to you by the hospital staff . 

  • Unclamp the lumen before attempting to flush forward.

  • Push the plunger slowly so that the saline goes into the port.

  • Do NOT flush forward if you meet any resistance.

  • Reclamp the lumen when you are finished.

  • Repeat the above steps if you need to flush your catheter with heparin.

Discard Your Materials

• Don't recap the needle after you have used it.

• Throw the needle and syringe away in your puncture-proof container. When the container is full, take it back to your healthcare facility for correct biohazard disposal.

• Discard any other materials in the trash can.

Follow-Up

• You will be followed closely by a home health nurse or TPN nurse.

• Make a follow-up appointment as directed by our staff.