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Discharge Instructions: Flushing Your Total Parenteral Nutrition (TPN) Catheter

You are going home on total parenteral nutrition (TPN). This is a way for you to get nutrition through a tube (catheter) in your vein. The TPN solution has the vitamins, minerals, and protein that you normally get by eating food. Your healthcare provider will decide if you can also eat while you are on TPN.

You will need to keep your catheter from clogging. This is done by flushing the catheter with saline solution. You may also need to flush your catheter with a medicine called heparin after the saline flush. This depends on the type of catheter you have.

You will work closely with a nurse until you feel comfortable taking care of your catheter and giving yourself TPN.

This sheet tells you how to flush your catheter. It has reminders and tips about what you’ll need to do each day. Ask your healthcare provider for more information about caring for your catheter, using sterile technique, and adding medicines to your solution. There are additional sheets available to guide you.

Home care

Find out if your catheter is open-ended or closed-ended.

  • Open-ended catheters must be flushed with saline before starting TPN. They must be flushed with heparin and saline after stopping TPN.

  • Closed-ended catheters must be flushed with saline before and after TPN.

Step 1. Wash your hands

Wash your hands before touching any of your supplies:

  • Turn on the water.

  • Wet your hands and wrists.

  • Use liquid soap from a pump dispenser. Work up a lather.

  • Scrub your hands thoroughly.

  • Rinse your hands with your fingers pointing down toward the drain.

  • Dry your hands with a paper towel. Cloth towels have germs. Use the paper towel to turn off the faucet.

  • Remember, once you have washed your hands, don’t touch anything but your supplies. You must wash your hands again if you touch anything else, such as furniture or your clothes.

Step 2. Gather your supplies

Your healthcare team will give you a list of specific items to use. Or you may be given a kit with all of the supplies. Your supplies may include:

  • For a saline flush:

    • Prefilled saline syringe

    • 25-gauge needle and 10 mL syringe (only if prefilled syringe is not provided)

    • 10 mL bottle of saline (only if prefilled syringe is not provided)

    • Disinfect supplies (such as chlorhexidine wipes or alcohol wipes)

  • For a heparin flush (if needed):

    • Prefilled heparin syringe (heparin in the amount prescribed)

    • 25-gauge needle and 10 mL syringe (only if prefilled syringe is not provided)

    • Disinfectant supplies (such as chlorhexidine wipes or alcohol wipes)

  • Trash can

  • Special container to throw out the used syringe (sharps container). You can buy a sharps container at a pharmacy or medical supply store. You can also use an empty laundry detergent bottle, or any other puncture-proof container and lid.

Step 3. Clean your work area

  • Take pets and children out of your work area.

  • Avoid working in the bathroom. It has too many germs.

  • Clean washable surfaces with soap and water. Dry with a paper towel.

  • Wipe surfaces that are not washable (such as fabric or wood) so they have no dust.  Spread a clean cloth or paper towel over your work surface.

  • Place your supplies on the cleaned and dried work surface.

  • Wash your hands again, using the steps for hand-washing listed above.

  • If you ever need to cough or sneeze, move away from your work surface.

Step 4. Prepare the syringe

  • Wipe the rubber top of the saline vial with an alcohol pad.

  • Attach the needle to the syringe. Be careful not to touch the opening at the bottom of the needle (hub) or tip of the syringe.

  • Remove the needle cap.

  • Fill the syringe with 10 mL of air for the saline flush.

    • If you are also using heparin, get a second syringe.

    • Fill the second syringe with air equal to the amount of heparin prescribed for your flush.

  • Stick the needle into the rubber top of the saline vial. Push air into the vial.

  • With the needle still in the vial, turn the vial upside down.

  • Pull back on the plunger to withdraw 10 ml of saline.

  • Be sure to keep the needle below the fluid level.

  • Check for air bubbles. Hold the syringe straight up and tap the barrel of the syringe with your knuckles. The bubbles should go to the top of the syringe.

  • Push out any air and extra fluid. The black line of the rubber piece attached to the plunger should be on the line next to the number 10 (ml) for saline.

  • Take the needle out of the vial.

  • If also using heparin, repeat the above process using the second syringe. Fill it with the prescribed amount of heparin. Be sure to check for air bubbles.

  • Put the cap back on the needle.

  • Be careful. Don't stick yourself.

  • Put the syringe down.

Step 5. Flush the catheter

  • Clean the injection cap on your catheter with disinfectant wipes or other supplies, as directed by your healthcare team. Using friction, scrub the top, the tip (including the threaded edges), and sides for 10 to 15 seconds.

  • Attach the syringe to the injection port as shown to you by the hospital staff. 

    • Unclamp the lumen before trying to flush forward.

    • Push the plunger slowly so that the saline goes into the port.

    • Do not flush forward if you meet any resistance.

    • Reclamp the lumen when you are finished.

    • Repeat the above steps if you need to flush your catheter with heparin.

Step 6. Discard your materials

  • Don't recap the needle after you have used it.

  • Throw the needle and syringe away in your sharps container. When the container is full, take it back to your healthcare facility for proper disposal.

  • Put any other materials in the trash can.

Follow-up care

  • You will be followed closely by a home health nurse or TPN nurse.

  • Make a follow-up appointment as directed by your healthcare provider.

When to seek medical care

Call your healthcare provider right away if you have any of the following:

  • A catheter that won’t flush

  • Excessive thirst

  • Upset stomach (nausea) or vomiting

  • Weakness, shakiness, or sweating

  • Headache

  • A very fast or abnormal heartbeat (heart palpitations)

  • Fainting or feeling faint

  • Sudden weight loss or gain (more than 2 pounds in 24 hours)

  • Fever above 100.4°F(38°C), or shaking chills

  • Redness, bleeding, swelling, warmth, drainage, or pus at your insertion site

  • Shortness of breath or any chest pain

 

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