Total Parenteral Nutrition
From Holoprosencephaly
This is an intravenous administration of nutrition used for patients who cannot or should not get their nutrition through eating.
TPN will drip through a needle or catheter placed in a vein for 10-12 hours, usually once a day or five times a week.
Chronic TPN is performed through a Hickman line or a Port-a-Cath (venous access systems). In infants, sometimes the umbilical artery is used.
The preferred method of delivering TPN is with a medical infusion pump. A sterile bag of nutrient solution, between 500 mL and 4 L is provided. The pump infuses a small amount (0.1 to 10 mL/hr) continuously in order to keep the vein open.
TPN solution is a combination of sugar and carbohydrates (for energy), proteins (for muscle strength), lipids (fat), electrolytes, and trace elements. A pharmacist will compound the solution based on the physician’s order.
Treatment effectiveness, side effects and nutritional status are monitored using laboratory tests and physical examinations.
Administration
Before administration of TPN, the solution should be examined closely. It should be clear and free of floating material. Gently squeeze the bag or observe the solution container to make sure there are no leaks. Do not use the solution if it is discolored, if it contains particles, or if the bag or container leaks.
It is important that medication is used exactly as directed. If infusion must be delayed or stopped for any reason (such as a blockage in the tubing, needle, or catheter) the health care provider should be notified immediately.
Side effects
Notify physician if any of these symptoms are severe or do not go away: mouth sores poor night vision skin changes
If any of these are experienced, the physician should be notified immediately: fever or chills stomach pain difficulty breathing rapid weight gain or loss increased urination upset stomach vomiting confusion or memory loss muscle weakness, twitching, or cramps swelling of the hands, feet, or legs thirst fatigue changes in heartbeat tingling in the hands or feet jumpy reflexes convulsions or seizures
Signs of infection
If you are receiving TPN in your vein or under your skin, you need to know the symptoms of a catheter-related infection (an infection where the needle enters your vein or skin). If you experience any of these effects near your intravenous catheter, tell your health care provider as soon as possible:
tenderness warmth irritation drainage redness swelling pain
Storing medication/solution
Several-days supply of total parenteral nutrition may be provided at a time. It should be stored in the refrigerator or freezer.
Take the next dose from the refrigerator 4-6 hours before using it; place it in a clean, dry area to allow it to warm to room temperature.
If additional total parenteral nutrition is stored in the freezer, always move a 24-hour supply to the refrigerator for the next day's use.
Do not refreeze medications.
Store medication only as directed. Make sure you understand what you need to store your medication properly.
Keep your supplies in a clean, dry place when you are not using them, and keep all medications and supplies out of reach of children. Your health care provider will tell you how to throw away used needles, syringes, tubing, and containers to avoid accidental injury
Source: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601166.html http://en.wikipedia.org/wiki/Total_parenteral_nutrition
Resources: http://www.naspghan.org http://www.nutritioncare.org/ - The American Society for Parenteral and Enteral Nutrition
For information about dealing with other potential health problems, treatments and medications, please visit our Miscellaneous Health Information category.
Click here to read what specialists have to say about caring for children with Holoprosencephaly: Doctor Q&A
If you have any concerns, please don't hesitate to discuss your concerns with your child's doctor(s).
