Discharge Instructions: Adding Medicine 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 (catheter) in your vein. The TPN solution has the vitamins, minerals, and other nutritional elements that you normally get by eating food. Your healthcare provider will decide if you can also eat food while you are on TPN. You will work closely with a nurse until you feel comfortable taking care of your catheter and giving yourself TPN.

Depending on your needs, you may need to add vitamins or medicine to your TPN solution. Never add anything to your TPN bag that has not been approved by your healthcare provider. In some cases, the medicine must be added just before infusing. Plan to add the vitamins or medicine to the TPN bag as you get it ready.

This sheet tells you how to add medicine to your TPN solution. It has reminders and tips about what you’ll need to do each day. Contact your healthcare team if you have questions about adding medicine to your TPN solution. Also ask your healthcare provider or nurse for more information about caring for your catheter, using sterile techniques, and flushing your catheter. Additional sheets are available to guide you.

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 for at least 20 seconds.

• Rinse your hands, keeping your fingers pointed downward toward the drain.

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

• Once you have washed your hands, be careful only to touch your supplies. You must wash your hands again if you touch anything else, such as furniture or your clothes.

• If you prefer, clean your hands using an alcohol-based hand sanitizer.

Step 2. Gather your supplies

There are different types of feeding bags and tubing systems. One type will require a syringe with a needle to inject medicines into the TPN bag. Another type lets you add vitamins and medicines to the bag without using a needle. Make sure you have the right supplies for your TPN bag.

Here's what you'll need:

• Alcohol pads

• Syringe with a 21-gauge, 1-inch needle attached (1 syringe for each medicine or vitamin you are adding to your solution). If you are using a needle-less system, you won't need the needle.

• Bottles (vials) of medicine or multivitamins, as prescribed

• Vial adapters for needle-less systems

• Special container called a sharps container to throw out the used needle and syringe. 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 with a lid.

• Trash can

Step 3. Clean your work area

• Keep pets and children out of your work area.

• Don't work in the bathroom. There are 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 that they are free of dust.

• Spread a clean cloth or paper towel over your work surface.

• Place your supplies on the clean, dry, covered work surface.

• Wash your hands again, using step 1 above.

• If you feel the need to sneeze or cough, turn away from your work surface.

Step 4. Get ready to inject

• Check the label on the bottle to make sure it is the correct medicine and dose. Also check the expiration date.

• Remove the protective cap from the bottle. Wipe the rubber top of the bottle with an alcohol pad. Insert the vial adapter if you are using a needle-less system.

• Remove the cover from the needle.

• Pull back the plunger to draw air into the syringe. The amount of air should be the same as the amount of medicine or vitamin you need to get from the bottle. For example, if you need 10 mL of medicine, draw in 10 mL of air.

• Insert the needle into the rubber top of the bottle or connect the needle-less syringe to the vial adapter. Push down on the plunger to get all the air into the bottle.

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

• If using a needle, be sure to keep the needle tip below the level of fluid in the bottle.

• 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 or disconnect the syringe from the vial adapter.

• Carefully replace the cap. If you are using a needle, be careful not to stick yourself as you replace the cap on the needle.

Step 5. Inject solution into the bag

• Check the expiration date on the TPN bag. Don't use it if it's expired. Also check the bag for problems. These include leaks, cloudiness, or things floating in it. Don’t use the bag if you see any of these things.

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

• If using a needle, remove the cap from the needle and insert the needle into the center of the bag’s injection port.

• Be careful not to make a hole in (puncture) the bag. Make sure you have put the needle in the center of the bag’s injection port.

• If you are using a needle-less system, screw the syringe onto the needle-less port.

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

• Remove the syringe (and needle, if used) from the TPN bag.

• Gently rock the TPN bag to mix the medicine into the TPN solution.

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

Step 6. Discard your materials

• Don’t re-cap the needle after you have used it.

• Place the syringe (and needle or vial adapter, if used) in your sharps container. If a needle is attached to the syringe, point the needle downward. When the container is full, follow the instructions for disposing of the container.

• Throw 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 advised.

When to call your healthcare provider

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

• Thirst

• Upset stomach (nausea) or vomiting

• Weakness, shakiness, or sweating

• Headache

• Feeling like your heart is racing or pounding (palpitations)

• Fainting or feeling faint

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

• Fever of 100.4°F ( 38.0°C ) or higher, or as advised by your healthcare provider

• Shaking chills

• Redness, swelling, or warmth at your catheter insertion site

• Drainage or pus from your catheter insertion site

Call 911

Call 911 if you have;

• Shortness of breath

• Any chest pain