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Discharge Instructions: Adding Medication to Your Total Parenteral Nutrition (TPN) Solution

You are going home on total parenteral nutrition (TPN). This is a way for you to get nutrition through a tube (called a catheter) in your vein. The TPN solution contains the vitamins, minerals, and energy that you normally get by eating food. Your doctor will decide whether or not you can also eat food while you are on TPN.

Each TPN vitamin or medication will be tailored to your needs. Some medications must be added to the TPN bag just before infusing. Add the vitamins or medication to the TPN bag as you prepare the bag for infusion.

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

This sheet describes the procedure for adding medication to your TPN solution. It contains reminders and pointers about what you’ll need to do each day. Ask your doctor or nurse for more information about caring for your catheter, using sterile technique, and flushing your catheter. There are additional sheets available to guide you.

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 toward the drain.

  • Dry your hands with a clean cloth or paper towel. Use this towel to turn off the faucet.

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

Gather your supplies

Here's what you'll need:

  • Alcohol pads

  • Syringe with a 21-gauge 1-inch needle attached (one for each medication or vitamin you are adding to your solution)

  • Medication vials and/or multivitamin vials as prescribed

  • Puncture-proof container to dispose of used needles and syringes (large glass jar that has a lid)

  • Trash can

Clean your work area

  • Shut pets and children out of your work area.

  • Avoid working in the bathroom; there are too many germs.

  • Clean washable surfaces with soap and water, and dry with a clean cloth or paper towel.

  • Wipe surfaces that are not washable (such as fabric or wood) so that they are free of 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 sneeze, be sure to move away from your work surface.

Prepare to inject

  • Remove the protective cap from the vial. Wipe the top of the vial with an alcohol pad.

  • Remove the cover from the needle.

  • Pull the plunger to draw air into the syringe equal to the amount of medication or vitamin you need to draw from the vial. (If you need 10 ml of medication, draw in 10 ml of air.)

  • Insert the needle into the rubber top of the vial. Push air into the vial.

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

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

  • Pull back on the plunger slowly until you have drawn up the correct amount.

  • Tap the barrel of the syringe to check for air bubbles. Push out any air or extra fluid. Remove the needle from the bottle.

  • Carefully replace the cap.

Inject solution into the bag

  • Wipe the injection port on the TPN bag with an alcohol pad.

  • Insert the needle into the center of the bag’s injection port.

  • Be careful not to puncture the bag. Make sure you have inserted the needle in the center of the bag’s injection port

  • Slowly push the plunger on the syringe, injecting the solution into the bag.

  • Remove the needle.

  • Mix the medication into the TPN solution by gently rocking the bag.

  • Repeat this procedure for each medication or vitamin that needs to be added.

Discard your materials

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

  • Throw the needle and syringe away in your puncture-proof container. Take the full container back to your healthcare facility for correct biohazard disposal.

  • Discard 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 our staff.

When to seek medical care

Call your doctor immediately if you have any of the following:

  • Thirst

  • Nausea or vomiting

  • Weakness, shakiness, or sweating

  • Headache

  • Heart palpitations

  • Fainting or feeling faint

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

  • Fever above 100.5°F (38.05°C) or shaking chills

  • Redness, swelling, or warmth at your insertion site

  • Drainage or pus from your insertion site

  • Shortness of breath

  • Any chest pain


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