Total Parenteral Nutrition (patient information)

About your treatment
Your doctor has ordered total parenteral nutrition (TPN) for you. TPN will drip through a needle or catheter placed in your vein for 10-12 hours, once a day or five times a week.

TPN is used for patients who cannot or should not get their nutrition through eating. Your TPN may include a combination of sugar and carbohydrates (for energy), proteins (for muscle strength), lipids (fat), electrolytes, and trace elements. Your solution may contain all or some of these substances, depending on your condition.

Even though TPN often includes lipids, it will not make you fat. Everyone needs calories, protein, and fat, in addition to other substances, to stay healthy.

Electrolytes include sodium, potassium, chloride, phosphate, calcium, and magnesium. Trace elements include zinc, copper, manganese, and chromium. Electrolytes are important for maintaining almost every organ in your body. They help your heart, muscles, and nerves to work properly and keep you from becoming dehydrated.

Your health care provider (doctor, nurse, or pharmacist) may measure the effectiveness and side effects of your treatment using laboratory tests and physical examinations. It is important to keep all appointments with your doctor and the laboratory. The length of treatment depends on how you respond to the medication.

Precautions
Before administering total parenteral nutrition


 * tell your doctor and pharmacist if you are allergic to any drugs.
 * tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially dexamathasone (Decadron); medications for diabetes, high blood pressure, or heart disease; prednisone; tetracycline; and vitamins.
 * tell your doctor if you have or have ever had diabetes or heart, kidney, liver, lung, or Addison's disease.
 * tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding, so that the risks and benefits of receiving TPN can be discussed. If you continue to receive TPN while you are pregnant or breast-feeding, your doctor may change the combination of sugar, protein, fat, and other elements.

Administering your medication
Before you administer TPN, look at the solution closely. It should be clear and free of floating material. Gently squeeze the bag or observe the solution container to make sure there are no leaks. Do not use the solution if it is discolored, if it contains particles, or if the bag or container leaks. Use a new solution, but show the damaged one to your health care provider.

It is important that you use your medication exactly as directed. Do not change your dosing schedule without talking to your health care provider. Your health care provider may tell you to stop your infusion if you have a mechanical problem (such as a blockage in the tubing, needle, or catheter); if you have to stop an infusion, call your health care provider immediately so your therapy can continue.

Minor Side Effects
''Total parenteral nutrition may cause side effects. Tell your health care provider if any of these symptoms are severe or do not go away:''


 * mouth sores
 * poor night vision
 * skin changes

Severe Side Effects
If you experience any of the following symptoms, call your health care provider immediately:


 * fever or chills
 * stomach pain
 * difficulty breathing
 * rapid weight gain or loss
 * increased urination
 * upset stomach
 * vomiting
 * confusion or memory loss
 * muscle weakness, twitching, or cramps
 * swelling of the hands, feet, or legs
 * thirst
 * fatigue
 * changes in heartbeat
 * tingling in the hands or feet
 * jumpy reflexes
 * convulsions or seizures

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

Storing your medication
Your health care provider probably will give you a several-day supply of total parenteral nutrition at a time.You will be told to store it in the refrigerator or freezer. Take your next dose from the refrigerator 4-6 hours before using it; place it in a clean, dry area to allow it to warm to room temperature. If you are told to store additional total parenteral nutrition in the freezer, always move a 24-hour supply to the refrigerator for the next day's use. Do not refreeze medications.

Store your medication only as directed. Make sure you understand what you need to store your medication properly.

Keep your supplies in a clean, dry place when you are not using them, and keep all medications and supplies out of reach of children. Your health care provider will tell you how to throw away used needles, syringes, tubing, and containers to avoid accidental injury.

In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Signs of infection
If you are receiving TPN in your vein or under your skin, you need to know the symptoms of a catheter-related infection (an infection where the needle enters your vein or skin). If you experience any of these effects near your intravenous catheter, tell your health care provider as soon as possible:


 * tenderness
 * warmth
 * irritation
 * drainage
 * redness
 * swelling
 * pain

Other names

 * TPN