How to administer your total parenteral nutrition (TPN)

Hi, I'm Helen and I'm going to walk you through how to administer your TPN, or Total Parenteral Nutrition therapy.

You'll be using a pump to make sure you get the right amount of TPN at the rate your doctor prescribed.

The pump will come already programmed for you by our Coram clinicians.

There are 9 steps you'll need to follow and you can jump to anyone at any time using the chapters below.

Let's start by making sure you're using a clean area at home.

You can wash the surface with soap and water or a disinfectant wipe.

You can use your sash preparation mat as a clean work surface.

Use soap and water or disinfectant wipes after each use to keep your sash mat clean.

Now go ahead and wash your hands really well for at least 20 seconds.

Apply enough liquid soap to cover the entire surface of your hands.

Use a nail brush to clean under your nails if needed.

Rinse your hands thoroughly and dry them with a paper towel or clean unused hand towel and use that same towel to turn off the faucet.

If you do not have access to soap and water, use an alcohol based hand sanitizer.

Making sure you have a clean area and clean hands during every step is really important to help prevent infection.

You'll also want to check your TPN bag and labels for the correct patient name, correct solution, correct dose, and that it is not expired.

The solution should be consistent in color and free of any visible particles.

If it's not, call us right away.

Your TPN formula bag should always be stored in your refrigerator at between 36 and 46°F.

Make sure there's enough space in the fridge and that it's clean.

Use soap and water or a bleach solution to clean the shelves.

Put the bags on the top shelf so nothing can spill on them.

To get the TPN formula to room temperature, take the bag from the refrigerator and place it on a clean countertop about two to three hours before infusing.

Never try to warm the formula up faster in any way.

You can take the bag out of the refrigerator as much as four to six hours before you plan to use it.

TPN formula is good for 24 hours at room temperature.

Next, make sure you've got all your supplies ready to go on your sash mat or other clean work surface.

Infusion pump, batteries, pump tubing, TPN infusion bag at room temperature.

Additive medication at room temperature, syringes and needles for drawing up and adding additives to your TPN bag.

Antiseptic protective caps, 2 prefilled saline syringes,1 prefilled heparin syringe if ordered.

Alcohol pads, pump carrying pack, sharps container.

Once all your supplies are ready, wash your hands again for at least 20 seconds.

If you touch something other than your supplies after washing your hands, you need to re wash your hands or you can use an alcohol based hand sanitizer.

Now it's time to prepare your additives.

If you're adding multivitamins to your TPN bag, there will be two vials.

You may use the same syringe for each vial.

Be sure to check your label every time so you inject the correct additives in the correct amount, since the amounts ordered by your doctor can change over time.

Pop the plastic cover off each additive bottle, then wipe the top with an alcohol pad, leaving the pad on top of the bottle without turning it over.

You should only touch one side of the pad.

Scrub the rubber injection port with a new alcohol pad for at least 15 seconds and let it air dry for five seconds.

Make sure you don't touch it with your fingers or let it touch any surface after it's cleaned.

To draw up your additives, you'll first want to twist the syringe needle clockwise to secure it and then take the cover off.

Pull back on the plunger to draw the air into the syringe that is equal to the volume of fluid to be withdrawn from the vial.

For example, if you're drawing up 5 milliliters of additive, drop 5 milliliters of air in the same syringe first.

Insert the needle into the center of the vial.

Gently push on the plunger to put air into the vial.

To withdraw the medication ordered by your doctor, turn the vial upside down and keep the needlepoint towards the bottom of the vial.

Pull back the plunger to remove the amount of fluid that equals the dose of medication your doctor prescribed.

Pull the syringe from the vial once the right amount of medication is in the syringe.

Now remove all air from the syringe.

Slowly push the plunger to add the medication to the bag.

Do this with each additive your doctor has ordered for you as listed on your label.

When finished, throw the needles into your sharps container.

You can throw the additive bottles away in your regular trash or as instructed by your Coram nurse or pharmacist.

Go ahead and gently need the TPN bag so the medication mixes completely into the solution.

The next few steps are to prepare your IV tubing and attach it to your TPN bag.

Tubing will be specific to the type of solution you have as instructed by your nurse.

Remove the pump tubing from the package, uncoil it and close the clamp.

Put the TPN bag on an edge so nothing can touch the ports.

Now, without touching the end of the TPN port with your fingers, remove the tab.

Next, take the protective cover off the spike end of the IV tubing, being careful not to touch the end, and then push the spike into the TPN port, twisting as you push it so it reaches the Ridge.

Once you have spiked your bag, you will load the tubing into the pump, following the instructions for the specific pump you are using.

You can watch our videos on how to use the CAD Solis and curling pumps for step by step instructions.

They are available in the Resource Center on our website.

Turn on the pump and check that the pump program matches your label as prescribed by your doctor.

Make sure you have replaced the batteries as required.

Now open the clamp and prime the tubing using the pump.

When priming your tubing, hold the filter in a vertical position with the flow downwards to allow the filter to completely fill with fluid.

Leave the protective cover on the end and hold it over its package or another small clean container to catch any drops.

It's important to be careful with the end of the tubing, you don't want it to touch anything and become contaminated.

Now your TPN bag, pump, and tubing are ready to go.

It's likely you heard us talk about SASH or S-A-S-H to help you remember several of the steps, and we're going to use SASH again today.

The first part of SASH is the saline, which you'll use to flush your catheter.

If you have a double lumen catheter, flush as directed by your nurse or pharmacist.

Hold the saline syringe with the tip pointing up and press firmly on the plunger while the tip cap is still on until you feel a click or see the plunger move.

Then loosen the tip cap and gently push the plunger forward to remove any air.

Retighten the cap before placing the syringe back down.

Use an alcohol pad to clean the injection cap for 15 seconds and let air dry for five seconds.

Be careful not to touch the top of the injection cap with your fingers.

Go ahead and open the clamp on your IV catheter or extension set.

Remove the tip cap from the saline syringe, then push the saline syringe onto the injection cap and twist it clockwise until it's secure.

The tip of the syringe is sterile, so don't touch it or lay it down on any surface while the cap is removed.

If it does come in contact with something, throw it away and get a new one.

Push the plunger and slowly to flush the catheter with as much saline as instructed.

If you don't know how much to use, call us and we'll confirm.

Administer your saline flush as instructed by your nurse.

This can be done slow and steady or by the pulse method.

To use the pulse method, push the plunger, stop for a second, and then push the plunger again.

When you have flushed all of the saline into the catheter, remove the syringe from the injection cap and discard the syringe as instructed by your nurse.

One note, if it's hard to push in the plunger during any flush, check to make sure all the clamps are open.

And if you have pain, burning, or swelling when flushing, stop right away and call us.

Now you're ready to administer your TPN.

First, scrub the catheter injection cap with the new alcohol pad for 15 seconds and let it air dry for five seconds.

Be careful not to touch the top of the injection cap with your fingers.

Take the protective cap off the end of the pump tubing, being careful not to touch the sterile end with your fingers.

Connect the end of the pump tubing to the catheter injection cap by pushing and turning it clockwise until it's secure.

Make sure all the clamps are open on the tubing and start the pump.

Your nurse will show you how to start your pump.

It's pre programmed to run over the amount of time and at the rate ordered by your doctor.

For your safety, these settings are locked, so you'll just be confirming the settings the same way every time you use it.

Always check the pump program to make sure it matches the information on your label.

You can either hang the TPN bag on an IV pole or put it and the pump into the backpack so you can move around during your therapy.

Then take a deep breath.

You're doing great.

When your pump signals that the infusion is done, stop the pump.

When it is time to change your TPN bag, you will repeat steps 2 through 5, including preparing your new TPN bag, replacing your pump batteries, priming your new tubing, and administering a saline flush.

If your TPN is running for less than 24 hours and this is the end of your infusion, proceed to the following steps.

Disconnect the TPN tubing from the injection cap.

Now you'll do another saline flush, the third part of SASH, and you'll follow the same steps as earlier.

Hold the saline syringe with the tip pointing up and press firmly on the plunger while the tip cap is still on until you feel a click or see the plunger move.

Then, loosen the tip cap and gently push the plunger to remove any air.

Re tighten the cap before placing the syringe back down.

Use a new alcohol pad to clean the injection cap for 15 seconds and let air dry for five seconds.

Be careful not to touch the top of the injection cap with your fingers.

Remove the tip cap from the saline syringe, then push the saline syringe onto the injection cap and twist it clockwise until it's secure.

The tip of the syringe is sterile, so don't touch it or lay it down on any surface while the cap is removed.

If it does come in contact with something, throw it away and get a new one.

Push the plunger in slowly or use the pulse method to flush the catheter with as much saline as instructed.

If you do not know how much to use, call us and we'll confirm.

If you were given heparin and told to use it to flush your catheter, continue with these next steps.

Otherwise, you can jump right to step 8, which is capping and securing your catheter.

The heparin flush is the last part of SASH.

Hold the heparin syringe with the tip pointing up and press firmly on the plunger while the tip cap is still on until you feel a click or see the plunger move.

Then loosen the tip cap and gently push the plunger to remove any air.

Retighten the cap before placing the syringe back down.

Use a new alcohol pad to clean the injection cap for 15 seconds and let air dry for five seconds.

Be careful not to touch the top of the injection cap with your fingers.

Remove the tip cap from the heparin syringe.

Then, push the heparin syringe onto the injection cap and twist it clockwise until it's secure.

The tip of the syringe is sterile, so don't touch it or lay it down on any surface while the cap is removed.

If it does come in contact with something, throw it away and get a new one.

Push the plunger in slowly or use the pulse method to flush the catheter with as much heparin as instructed.

If you do not know how much to use, call us and we'll confirm.

When you're done, take the syringe off the injection cap and clamp the catheter or extension set.

To help prevent infection, put an antiseptic cap on the end of your catheter now by peeling the seal off the cap and attaching the cap to the end of the catheter.

You'll want to secure your catheter.

Your nurse will show you how to do this.

Next, check that the pump is turned off and relax.

You're done with your infusion.

Now your final step is clean up.

Go ahead and throw away the used alcohol pads into your trash.

You can also throw your used flush syringes into your trash unless your nurse has told you to dispose of them in your sharps container.

Don't disconnect the tubing from the TPN bag.

Instead, remove the tubing from the pump and throw both the bag and the tubing in the trash.

Clean your sash mat and put it away for next time.

This may all seem a bit overwhelming at first, but once you do this a few times, you'll feel more comfortable.

And remember, as a Coram patient, our team is here for you 24 hours a day, seven days a week.

Thank you for watching today.