Symptom and description

When weight loss or the inability to eat becomes severe, nutrition can be given right into a vein. You may hear this called TPN for total parenteral nutrition. TPN allows you to get the water, fat, protein, vitamins, and other nutrients your body needs for energy. This special nutrition solution can be given into an implanted port, a tunneled tube (catheter), or any other long-term catheter placed in a large vein. Nutrition like this may be needed if you can’t handle taking food by mouth or your bowel needs to rest.

Learning needs

You will need to learn to care for the catheter and learn to give yourself the nutrients. You may want to have a family member or friend learn how to do these things, too. You may have a home health nurse visit to keep track of your health, nutritional feedings, and catheter site. Your nutrition solution will be given on a schedule that best fits your needs for care and the amount of calories needed. Your healthcare provider or dietitian will explain the schedule that is best for you. The choices of schedules are:

• Continuous. The amount of solution for the day will be given slowly over the 24-hour period.

• Cyclic. The amount of solution for the day will be given periodically—for example, over a 12-hour period.

You will also need to learn about some of the problems that can happen with nutrition solutions and what to report to your healthcare provider.

Preventing problems

Parental feeding is important in giving you the nutrients you need. When care is taken to give the solution safely, many problems can be prevented. These are some of the problems that can develop:

Blood sugar changes

You will need to have your blood sugar checked often. This is especially important when you first start getting parenteral nutrition. You may be taught to do this at home. You will be taught to watch for signs of high and low blood sugar levels. Contact your healthcare provider if you have these signs of blood sugar problems:

• High blood sugar. Your blood sugar level may go up due to the amount of sugar in the solution. Symptoms of high blood sugar include dry, hot, flushed skin. They also include thirst, severe tiredness (fatigue), frequent urination, and upset stomach.

  • Special medicine called insulin may need to be added to your nutrition solution.

  • The type of solution may need to be changed.

• Low blood sugar. Your blood sugar may become low if there is an interruption in the infusion of the nutrient solution. The symptoms are sweating, nervousness, shaking of hands, hunger, weakness, irritability, numb tongue or lips, and headache.

  • Infuse the solution at the rate you have been instructed to use.

  • Should low blood sugar happen, try to eat several pieces of hard candy if approved by your healthcare provider. Symptoms should go away quickly.

  • Don’t stop or interrupt the solution without calling your healthcare provider first.

Infection

Clean the catheter daily and any time it gets wet as follows or as instructed by your healthcare provider or nurse:

• Wash your hands before touching the catheter or dressing. Wash for at least 20 seconds with soap and clean, running water (warm or cold).

• Use only sterile methods when changing the dressing of the catheter, flushing it, or hooking up the solution. You will be taught how to do this. Make sure you understand exactly what to do.

• Remove the old dressing, being very careful not to pull the tube or dislodge the needle. Put on the new dressing as instructed by your healthcare provider. Call your healthcare provider if the catheter seems to be coming out or the part outside your body seems to have changed in length.

• Check for redness, soreness, or drainage every time you change the dressing. Call your healthcare provider if you see any signs of concern.

• Use new, sterile syringes and tubing every time.

• Your solution should be clear and free of floating material. Before using the solution, gently squeeze the bag to be sure there are no leaks. Don't use the nutrient solution if the bag leaks or if the solution looks cloudy or has particles in it. Call your healthcare provider or pharmacist for instructions.

Catheter problems

Your healthcare provider or nurse will teach you how to use your catheter safely and troubleshoot problems. Here are some of the more serious problems you should know about. If any of these happen, call your provider or get medical care right away:

• Catheter damage. This can be caused by using a lot of force to flush it or clamping in the wrong place or at the same place every time. Talk with your nurse about what you should do if the catheter gets a hole or leak. You may be given a special scissors-like clamp to put between the leak and the place the catheter goes into your body until you get medical help.

• Air embolism. This is when a lot of air goes into the catheter and into your blood. This can be prevented. You will be taught how to "flush" the tubing to get the air out before hooking it up to your catheter. There may be special filters along the tubing to trap air, too. You will also be taught how to use the clamps and safely change the caps.

• Blocked catheter. If you can’t flush the catheter (and you're sure the clamps are open), it may be blocked. Don’t try to forcefully flush it. There are special medicines that can be used to open it.

• Blood clots. These are possible, and the vein that the catheter is in can become red, irritated, and painful. These can be prevented with regular, safe catheter care.  

Management

Follow these tips for managing your parenteral feedings: 

• Follow all the instructions on how to use your catheter and give feedings very carefully. Call your healthcare provider or nurse any time you have questions or concerns.

• Have blood tests for sugar level drawn as directed.

• Don't adjust the rate of nutrition solution or stop your therapy without talking with your healthcare provider. Parenteral nutrition is stopped slowly and under medical supervision. The amount is decreased a little at a time until you can take food by mouth or use other nutritional support methods, such as enteral tube feedings.

• If you have any questions, call your healthcare provider. 

Follow-up

Follow-up suggestions include:

• Talk about any problems with infusions with your healthcare provider or dietitian.

• Tell your healthcare provider right away if any of the following happens:

  • Fever of 100.4°F (38ºC) or higher, or as directed by your healthcare provider

  • Chills

  • Soreness, drainage, or redness at catheter site

  • Neck or arm swelling

  • High blood sugar: dry, hot, flushed skin; thirst; fatigue; frequent urination; upset stomach

  • Low blood sugar: sweating, nervousness, shaking of hands, hunger, weakness, irritability, numb tongue or lips, headache

  • Leaky or damaged catheter

Be sure you know what other problems you should watch for and how to get help any time. Know what number to call to reach your healthcare provider after office hours, on weekends, and on holidays.