Total parenteral nutrition

Hyperalimentation; TPN; Malnourishment - TPN; Malnutrition - TPN

Description

Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. A special formula given through a vein provides most of the nutrients the body needs. The method is used when someone can't or shouldn't receive feedings or fluids by mouth. A person may need TPN for a short time over weeks or months, or for life. It depends on the condition that causes the need for TPN.

You'll need to learn how to do TPN feedings at home. You'll also need to know how to care for the tube (catheter) and the skin where the catheter enters the body.

Follow any specific instructions your health care provider or nurse gives you. Use the information below as a reminder of what to do.

What to Expect at Home

Your provider will select the right amount of calories and TPN solution. Sometimes, you can also eat and drink while getting nutrition from TPN.

Your nurse will teach you how to:

  • Take care of the catheter and skin
  • Operate the pump
  • Flush the catheter
  • Deliver the TPN formula and any medicine through the catheter

It is very important to wash your hands well and handle supplies as your nurse told you to prevent infection.

You will also have regular blood tests to make sure the TPN is giving you the right nutrition.

Preventing Infection

Keeping hands and surfaces free of germs and bacteria will prevent infection. Before you start TPN, make sure the tables and surfaces where you will put your supplies have been washed and dried. Or, place a clean towel over the surface. You will need this clean surface for all of the supplies.

Keep pets as well as people who are sick away. Try not to cough or sneeze on your work surfaces.

Wash your hands thoroughly with an antibacterial soap before TPN infusion. Turn on the water, wet your hands and wrists and lather up a good amount of soap all over for at least 15 seconds. Then rinse your hands with fingertips pointing down before drying with a clean paper towel.

Getting the TPN Bag Ready

Keep your TPN solution in the refrigerator and check the expiration date before use. Throw it away if it is past the date.

Do not use the bag if it has leaks, change in color, or floating pieces. Call the supply company to let them know if there is a problem with the solution.

To warm the solution, take it out of the refrigerator 2 to 4 hours before use. You can also run warm (not hot) sink water over the bag. Do not heat it up in the microwave.

Before you use the bag, you will add special medicines or vitamins. After washing your hands and cleaning your surfaces:

  • Wipe the top of the cap or bottle with an antibacterial pad.
  • Remove the cover from the needle. Pull back the plunger to draw air into the syringe in the amount your nurse told you to use.
  • Insert the needle into the bottle and inject the air into the bottle by pushing on the plunger.
  • Pull back the plunger until you have the right amount in the syringe.
  • Wipe the TPN bag port with another antibacterial pad. Insert the needle and slowly push the plunger. Remove.
  • Gently move the bag to mix the medicines or vitamin into the solution.
  • Throw away the needle in the special sharps container.

Using the Pump for TPN

Your nurse will show you how to use the pump. You should also follow the instructions that come with your pump. After you infuse your medicine or vitamins:

  • You will need to wash your hands again and clean your work surfaces.
  • Gather all of your supplies and check the labels to make sure they are correct.
  • Remove the pump supplies and prepare the spike while keeping the ends clean.
  • Open the clamp and flush the tube with fluid. Make sure no air is present.
  • Attach the TPN bag to the pump according to the supplier's instructions.
  • Before the infusion, unclamp the line and flush with saline.
  • Twist the tubing into the injection cap and open all clamps.
  • The pump will show you the settings to continue.
  • You may be directed to flush the catheter with saline or heparin when you are finished.

When to Call the Doctor

Contact your provider if you:

  • Have trouble with the pump or infusion
  • Have a fever or a change in your health

References

Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Nutritional management and enteral intubation. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 16.

Ziegler TR. Malnutrition: assessment and support. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 204.

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Review Date: 10/1/2022

Reviewed By: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.


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