Getting Started

Your Focus Rx TPN Pharmacist will call you to introduce you to the process of Home Infusion, and to arrange your TPN delivery. Your Pharmacist will ask you a series of basic questions, to make sure we are developing the best care plan for you. Make sure someone will be home to receive your TPN. A TPN Pharmacist is on call 24 hours a day, 7 days a week in case of a care-related, urgent issue. If you have a true emergency, call 911.

Your Focus Rx TPN Dietitian will work with your Doctor and Pharmacist to determine the best TPN formula for your needs, and will help monitor your lab work and clinical signs/symptoms to ensure you tolerate the formula.

Your RN will arrange to meet you at your home to show you and a caregiver all you need to know in order to connect and disconnect your TPN, as well as how to care for your IV line.

Your Nutrition Focus NST will assist you and answer all your questions, throughout the course of your home care.

 

 

 

Receiving and Storing Your TPN

When you receive your TPN shipment:

1. Check the label to make sure it is YOUR TPN, and that it is not expired.
2. Compare the TPN delivery form with the formula on the TPN bag. If there is a mistake,
do not use the TPN. Call your TPN Pharmacist right away so the proper formula can be shipped to you.
3. Store your TPN in a dedicated spot in a refrigerator kept at 40 degrees Fahrenheit.

How to refrigerate your TPN:

  • Keep a thermometer in the refrigerator to make sure it stays at the proper temperature. Refrigerator thermometers can be obtained inexpensively in a wide variety of stores, from Amazon to Walmart.
  • Make sure the refrigerator is kept clean, using a bleach solution of 1 part bleach: 10 parts water.
  • Keep TPN bags from coming into contact with food while in the refrigerator. Some patients find it is helpful to have a separate, dorm or apartment-sized refrigerator designated specifically for their TPN.
  • Rotate the TPN bags to ensure you don’t accidentally let some expire.

 

 

Setting Up Your TPN Infusion

First, be sure to take your TPN out of the refrigerator about 6 hours before you infuse it to allow it to come to room temperature. Let your TPN warm up on its own, without a source of heat, hot water, or direct sunlight to warm it up.

Next, set out the following supplies:

  • IV tubing with 1.2-micron filter (your RN will show you what that is)
  • Your TPN bag (now at room temperature)
  • Infusion pump with battery for backup
  • Two syringes of 0.9% sodium chloride (saline solution)
  • One syringe of Heparin Lock Flush
  • Alcohol pads
  • Thermometer

Be sure to wash your hands thoroughly for at least 15 seconds, using foam or liquid soap. Check your temperature and document it.

 

 

Adding Insulin or Vitamin K to Your TPN

If this is part of your prescription, it must be done prior to adding multi-vitamins to your TPN.

**If adding both insulin and vitamin K, add the insulin first.**

  1. Set out the following supplies:
    • Alcohol Pads
    • Prefilled insulin syringe and one-inch (22 gauge) needle that goes with the syringe
    • Prefilled vitamin K syringe and the needle that came with it
    • That day’s TPN bag
  2. Wash your hands thoroughly for a minimum of 15 seconds. Be sure to clean under nails and under rings. Liquid or foaming soap is better than bar soap, which can harbor germs.
  3. Check the label on the syringe for your name, medication name, dose, and expiration date for accuracy. If any of the information is wrong, set the syringe aside and call your Focus Rx Pharmacist for instructions.
  4. Take the plastic or rubber cap off of the syringe, but be sure not to touch the tip.
  5. Twist the needle onto the syringe.
  6. Find the short, rubber or plastic port at the bottom of the TPN bag and wipe it vigorously with a fresh alcohol pad for 15 seconds. Let air-dry.
  7. Pull the cover straight off of the needle, without twisting or touching the needle.
  8. Insert the needle into the port and push the syringe contents into the TPN bag.
  9. Next remove the needle from the port, discarding needles and syringe into a safe sharps container.
  10. Repeat steps 3-9 for vitamin K injection, if that is part of your prescribed treatment.

 

Adding Your Vitamins to the TPN Bag

* Note: These instructions are for adult vitamin administration. Your RN will give you specific instructions if pediatric vitamins are required.

  1. Set out the following supplies:
  • Alcohol pads
  • Two vials of vitamins with different colored caps
  • Two 10-ml syringes with needles
  • Your TPN bag
  1. Wash your hands well for at least 15 seconds using foam or liquid soap. Be sure to clean under nails and under rings.
  1. Open one vial and use a new alcohol pad to scrub the top of it for 15 seconds. Let it air dry.
  1. Use a new alcohol pad to scrub the short rubber (or plastic) port at the bottom of your TPN bag for 15 seconds. Let it air dry.
  1. Take the cap off of one of the needles by pulling it straight off. Do not twist the cover, or touch the needle.
  1. Pull back the syringe’s plunger to fill it with 5 ml of air.
  1. Insert the needle into the center of the opened via, piercing the top of it, and push all the air into the vial.
  1. Keeping your thumb on the plunger of the syringe, turn the vial upside down, and draw all its liquid into the syringe.
  1. You may have very tiny (champagne sized) bubbles on the inside of the syringe. This is ok, but bigger bubbles need to be tapped out of the syringe.

Flick the side of the syringe with your finger to move any air bubbles to the top of the syringe. Then inject the air back into the vitamin vial.

  1. Pulling the needle from the vial, insert the needle into the center of the TPN bag’s port. Push all of the liquid into the TPN bag before removing the needle from the port. (Discard both the empty syringe and needle in the sharps container).
  1. Using the second syringe and vitamin vial, repeat steps 3-10.

 

 

Mixing the TPN and Lipids Together

If your TPN has a separate chamber with white milky liquid in it, then it has a lipid chamber that will need to be combined with the clear carbohydrate and protein component (See Combining TPN Chambers below). Lipids are fats that can be infused into veins. Check to make sure your lipid solution looks white and milky, and that the liquid at the bottom looks clear or slightly yellow in color.

Your Focus Rx TPN Pharmacists are experts in preventing and screening for instabilities in your TPN during and after formulation. However, it is always helpful for you to look out for these in your home, as well. See images below for examples of TPN instability.

Cracking TPN Bag - Baxter

Craking: where small fat particles fuse together to form larger fat particles

image005

Marbling: occurs when oil separates from the rest of the TPN solution

image006

Creaming: occurs when fat particles accumulate at the top of the solution

 

* If you see anything unusual about your TPN, do not use it. Instead, call your Focus Rx pharmacist.

 

 

 

 

 

 

Images Courtesy of Baxter Healthcare Corporation.  All rights reserved.

Combining TPN Chambers

Once you’ve checked your TPN to make sure it looks as it should, pull the rubber strip from between the two chambers.

Then gently knead the bag until the liquids are well-mixed.

(Do these steps when you are ready to connect it to your IV.)

* If you see anything unusual about your TPN, do not use it. Instead, call your Focus Rx pharmacist.

 

Attaching and Priming Your Tubing

Please note that these instructions are specifically for the Moog Curlin Infusion Administration Sets

Remove the IV tubing from its package. Prior to connecting tubing to your TPN bag, twist and pull off the yellow breakaway tab on top of the yellow integral flow stop (see video). This prevents unregulated flow through the tubing caused by gravity.

Locate the large middle port at the bottom of your TPN bag. Hold the TPN bag and remove the seal from that port. Do not touch the open port (even to clean it) once the seal is removed. Do not use the port that is clamped.

There is a spike at the end of your tubing. Take the cap off of it. Push the spike into the middle port of the TPN bag. Be sure to twist the spike as you push it into the TPN bag.

Next raise the bag. You can place it onto your shoulder, or hang it from an upper kitchen cabinet, or hang it from an IV pole.

When priming keep the vented blue cap on to prevent contamination.

To prime manually, slide the white clamp sideways to unclamp the tubing. Next, squeeze the yellow integral flow clip to allow fluid to flow through to the end of the tubing. Release the yellow flow stop clip when the set is fully primed.

 

 

Download our TPN Education Guide

Our Dietary Guide for Short Bowel Syndrome serves as a general dietary concepts guide to help you understand foods you should avoid and those that are beneficial. While your should always discuss any dietary changes with your doctor, our guide is written by our in-house Registered Dietitian Nancy Cincotta MS, RD.

Click the image to download the pdf

TPN Education Guide - Focus Rx

Curlin Pump Videos

 

 

WE PROMISE TO INSPIRE OUTSTANDING CUSTOMER SERVICE AND DELIVER POSITIVE PATIENT OUTCOMES.

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