TPN Management

Total parenteral nutrition (TPN) is utilized for patients who cannot or should not get their nutrition orally or enterally when the gastrointestinal tract is not functioning, hence the term “parenteral.”  Parenteral refers to administration not delivered via the gastrointestinal tract.  Therefore, TPN will be administered intravenously to patients through a vascular access device into a central vein only.  It can be used when caloric needs are very high, when the anticipated duration of therapy is greater than 7 days, or when the solution to be administered is hypertonic (composition of greater than 10% dextrose).  

TPN may include a combination of all the substances that maintain our health, including:  sugar and carbohydrates for energy, proteins for muscle strength, lipids as a source of fat, electrolytes, and trace elements. Electrolytes include sodium, potassium, chloride, phosphate, calcium, and magnesium. Trace elements include zinc, copper, manganese, and chromium. Electrolytes are important for maintaining almost every organ in your body.  They help your heart, muscles, and nerves to work properly and also keep you from becoming dehydrated.  TPN is commonly used in patients undergoing treatment for cancer, bowel disorders, and those suffering from trauma or extensive burns, as these conditions being associated with high caloric requirements.  Total Home Health works with most infusion therapy companies in the coordination and delivery of the medication and supplies.

Prior to beginning TPN your provider will perform laboratory tests to have as a baseline to refer to in case of emergency or if any changes occur during therapy.  Be sure to share with your provider if you have any allergies, and the list of the medications you are currently taking.  The depth of the initial assessment before TPN initiation will be unique to your personal diagnoses and situation.  During TPN therapy ongoing nursing assessment parameters include intake and output, daily weights, vital signs, pertinent laboratory values, and an ongoing evaluation of the patient’s underlying condition.  Per provider guidelines serum and urine glucose will be monitored.  Caregiver should monitor the flow rate carefully.

Before TPN is administered, remember to look at the solution closely. Do not use the solution if it is discolored, and make sure it is free of any floating material. Gently squeeze the bag or observe the solution container to make sure there are no leaks.  Definitely do not use the solution if it is discolored, has visible floating material, or if the bag is leaking.  Use a new solution, but make sure to show the damaged one to your health care provider.  It cannot be reinforced enough to make sure you use your medication exactly as directed.  Do not change your dosing schedule without consulting with your health care provider. 

Your provider may tell you to stop your infusion if you have a mechanical problem (such as a blockage in the tubing, needle, or catheter); if you have to stop an infusion, call your health care provider immediately so your therapy can continue as soon as possible.

Your provider will most likely give you a several-day supply of TPN at a time.  You will be instructed to store it in the refrigerator or freezer.  Before each use a bag of TPN solution should be taken from the refrigerator 4-6 hours before its use, remember to place it in a clean and dry area to allow it to warm up to room temperature.  If you must store additional TPN in the freezer, always move a 24-hour supply to the refrigerator so that it may be warmed within 4-6 hours.  Never refreeze TPN solutions.  Store TPN only as directed and make sure you understand what you need to store it properly.  Your provider will tell you how to dispose of any used needles, syringes, tubing, and containers to avoid any accidental injuries.

Total Home Health has a program available for patients requiring TPN.  You will not be alone in your journey, because with us you will always be informed of the best treatment options for your situation.