Preventing Infection

Keeping hands and surfaces free from germs and bacteria will prevent infection. Before your start TPN, make sure the tables and surfaces nearby 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 and 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 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 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.

To warm the solution, take it out of the refrigerator 2 to 4 hours before use. You can also run warm sink water over the bag. Never heat it up in the microwave.

Before you use the bag, you will add special medications 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 or doctor 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 medication or vitamin into the solution.
• Throw away the need 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 medication or vitamins:

• You will need to wash your hands as described above and clean your work surfaces.
• Gather all of your supplies and check the labels to make sure they are correct.
• Remove the CADD 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.

See also: Central venous catheter - flushing

When to Call the Doctor

Call your the doctor or nurse if you:

• Have trouble with the infusion
• Have trouble with the pump
• Notice a fever or a change in your child’s health

Alternate Names

Hyperalimentation; TPN

Update Date: 11/11/2012

Updated by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital; and George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.