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Getting Started with Total Parenteral Nutrition (TPN) at Home

What is TPN?

Total Parenteral Nutrition (TPN) is a way to provide your body with essential nutrients through a vein (IV). It’s used when your digestive system can’t process food normally. TPN contains protein, carbohydrates, fats, vitamins, minerals, and fluids to keep you healthy.

How is TPN given?

TPN is infused through a central line catheter (such as a PICC line, port, or tunneled catheter). It is usually given overnight or over several hours each day.

Getting your TPN mixture ready

Follow these steps to get your TPN mixture ready.

  1. Take your TPN out of the refrigerator 2 hours before you need to use it so that it can come to room temperature.
  2. Find a clean place to prepare the TPN mixture. Do not make your TPN in your bathroom or near pets. Use a place in your home that isn’t messy or dirty. A good place is the kitchen or dining area. Choose a smooth surface, like a table or a counter-top, that isn’t near an open window or doorway. Clean the surface with soap and water and dry it with a paper towel.
  3. Make sure you have all the equipment listed below:
  4. IV administration set (Sapphire / Curlin) 
  5. Alcohol wipes
  6. A sharps container (container for sharp objects, like needles)
  7. TPN solution bag(s)
  8. IV pump 
  9. Alcohol wipes
  10. Saline and heparin flushes (if prescribed)

Before you start

  • Wash your hands thoroughly with soap and water.
  • Clean your workspace with a disinfectant.
  • Check the TPN bag label. Make sure it has your name, correct date, and ingredients. 
  • Take the TPN out of its protective bag. 

Preparing and adding medications to your TPN

Follow these steps to add medications to your TPN, if needed.

Gather any prescribed medications that you will need to add to your TPN bag. 

Medication Syringe
Adult MVI (Two 5mL vials)10 mL Syringe
Thiamine1 mL Syringe
Folic Acid 1 mL Syringe

Some bags have a divider near the middle of the bag that separates the mixture from the lipids. If your bag has this, you will remove it after you’ve added all of your medications.

  1. Check the medication label and expiration date. Make sure you have the correct medication and that it isn’t expired.
  2. Take off the protective cover from the top of the vial. Keep the alcohol wipe in its foil and clean the top of the vial with the wipe. Repeat this step for all the medications that you will add to your TPN bag.
  3. Clean the medication port of the TPN bag with an alcohol wipe. This is the port where you will inject the medication. The medication port may be located on the outside or middle of the TPN bag.
  4. Open another alcohol wipe fully. Put the clean medication port on a new alcohol wipe.
  5. Pick up a syringe and take off the protective cap.
  6. While holding the round end of the plunger at the bottom of the syringe, pull it back to the dose of medication that your healthcare provider prescribed.
  7. Clean the top of the medication vial with an alcohol wipe. Hold the syringe like a pen or pencil. Push the needle of the syringe into the rubber top of the medication vial. Push down the plunger so that the air enters the vial.
  8. Carefully turn the vial upside down with the needle still in it. Make sure that the medication covers the tip of the needle. Pull back the plunger to fill the syringe with the prescribed amount of the medication. Check to make sure that you have the right amount of medication in the syringe. Take the needle out and put the vial to the side.
  9. Put the needle into the medication port of your TPN bag. Inject the medication into the bag. When all the medication is in the bag, put the medication port on the alcohol wipe again. Put the syringe into your sharps container.
  10. Repeat steps 5 through 9 until all of your prescribed medications are injected into the TPN bag. Use a new syringe for each type of medication. Store any vials that you will use more than once in your refrigerator until they’re empty or expired.
  11. Gently rock the TPN bag to mix the medication(s) into the mixture. The mixture will go from clear to yellow. Check it for cloudiness or particles. If you see any discoloration, cloudiness, or particles, do not use the bag and call our pharmacy at 713-783-2836. 
  12. If you have added all your medications, you can now remove the divider from the middle of the TPN bag, if you have one. Gently rock the bag to mix the lipids with the mixture. Check the bag for fat or separation of lipids. Do not use the solution if you see any of fat or separation of lipids. 

Attaching the administration set to the TPN Bag

  1. Take the protective covering (pull-tab) off the TPN bag spike port and put it on the sterile barrier. Do not touch the exposed end or let it come in contact with anything.
  2. Pick up the TPN administration set. Hold it below the sharp end of the spike tip in one hand, and remove the protective covering.
  3. Insert the tip of the administration set completely into the spike port of the TPN bag using a twisting motion.

Starting your TPN

  1. Hang the TPN bag on an IV pole or hook. If you have a portable pump, you don’t need an IV pole.
  2. Hold the end of the TPN bag tubing over the garbage can. Squeeze the chamber of the administration set 1 time.
  3. Open the roller clamp and let the solution fill the entire length of the tubing, including the filter. The filter is a safety device that traps air bubbles and any particles while the solution is running through the tubes. Make sure that there is no air trapped in the tubing.
  4. When the tubing is filled, close the roller clamp. Thread the tubing through the infusion pump, using the instructions on your pump as a guide.
  5. Clean the CVC connection at the end of the lumen with an alcohol wipe.
  6. Flush the lumen that you’ll be using for the infusion with 10 mL of normal saline (see instructions in the “Disconnecting the TPN Tubing and Flushing Your CVC” section).
  7. Remove the protective cap from the TPN tubing.
  8. Carefully attach the TPN tubing to the CVC lumen. If you have a CVC with 2 or more lumens, try to switch between them when you do your TPN infusion. This way you know that each lumen works. Do not touch any open connections or allow them to touch anything. If the end of the TPN tubing accidentally touches something, replace it with a new administration set.
  9. To start the TPN, open the clamps on the lumen and the TPN tubing. Turn the infusion pump on.

Disconnecting the TPN tubing and flushing your CVC

Your pump will sound an alarm when your infusion is done. Now you will need to disconnect your TPN tubing from the CVC and flush your CVC. Your nurse will teach you how to do this and give you the supplies you will need.

  1. Gather your supplies. You will need: 
    • One prefilled, 10 mL syringe of normal saline solution. You will need 1 syringe for each lumen.
    • Nonsterile gloves
    • Alcohol wipes
  2. Wash your hands with warm water and soap for at least 20 seconds. Dry them with a clean towel or a paper towel.
  3. Put on a pair of nonsterile gloves.
  4. Turn off the infusion pump.
  5. Close the clamp in the TPN tubing and disconnect the TPN tubing from your CVC.
  6. To release the air bubbles in the syringe, gently tap the side of the syringe. Point the syringe up as you do this. Loosen but do not remove the cap on the syringe. Press the plunger on the syringe until the air is pushed out. Retighten the cap.
  7. Pick up 1 lumen and unclamp it.
  8. If you have a disinfection cap, remove it. If you don’t have a disinfection cap, scrub the end of the needleless connector with an alcohol wipe for 15 seconds and allow it to dry for 15 seconds.
  9. Remove the cap from the syringe. Throw away the cap. Make sure that nothing touches the clean end of the needleless connector while you are doing this.
  10. Carefully push the saline syringe into the needleless connector and twist it in a clockwise (to the right) until the connection feels secure.
  11. Start to inject the saline solution. If you can’t inject the saline, stop and check to be sure there are no twists or other blockages in the tubing. Try to inject the saline again. If you still can’t inject the saline, don’t use extra pressure to flush the line. Remove the syringe, re-clamp your catheter, and call your healthcare provider.
  12. Use the push/pause method to flush your catheter:
    • Quickly inject ⅓ of the saline
    • Pause
    • Repeat
    • Inject the last ⅓ of the saline.
    • After the last injection, clamp your catheter
  13. Untwist the syringe from the lumen and throw it away.
  14. Attach a disinfection cap to the end of the needleless connector.
  15. Repeat steps 7 to 14 for each lumen.
  16. Re-clamp the lumens.
  17. Secure your catheter in a way that makes you feel comfortable.
  18. Throw away your gloves and wash your hands.

You have now finished giving yourself TPN. Throw away all the disposable materials in the garbage.

Call your healthcare provider if you have:

  • A fever of 100.4° F (38° C) or higher
  • Severe pain around your catheter
  • Chills
  • Shortness of breath
  • Problems flushing your catheter
  • Any issues putting the TPN solution into your body
  • Blood or fluid leaking from your catheter tubing
  • Tubing that is broken or damaged