Patient education: Parenteral nutrition (The Basics)

What is parenteral nutrition? — "Parenteral nutrition," or "PN," is a way of getting food and nutrients into the body. It is used when a person cannot get enough nutrition in other ways. It is also called "intravenous," or "IV," feeding.

With PN, a person gets liquid nutrition directly into a vein by IV. This is done through a "central venous catheter," or "CVC." A CVC is a flexible plastic tube that goes into a large vein that leads to the heart. It connects to a bag of PN solution that provides nutrition. The solution contains specific amounts of different nutrients the body needs. These include proteins, fats, carbohydrates, sugars, vitamins, and minerals. Getting PN through a CVC is sometimes called "central PN," or "CPN."

If you need PN, your doctor will do a procedure to put in a CVC. There are different types of CVCs.

Why might I need PN? — A person usually needs PN because all or part of their digestive system is not working properly. This can happen with certain medical conditions or after surgery on the stomach or intestines. PN can also be used if you have lost a lot of weight without trying, cannot eat enough food, or need more of certain nutrients that you cannot get in other ways.

If you are not getting enough nutrients by mouth, doctors often place a feeding tube. This is a way to deliver nutrients directly into your stomach or intestines. But if this is not possible, or if you are still not getting enough nutrients this way, you might need PN.

PN is often given when you are getting treatment or recovering from surgery in the hospital. But in some cases, you can give yourself PN at home.

How do I care for the CVC at home? — If you are going home with a CVC, your doctor or nurse will talk to you about how to take care of it. It's important to follow all of the instructions to lower your risk of infection. Ask questions if there is anything you do not understand.

How do I feed myself with PN? — Your doctor or nurse will show you exactly how to give yourself PN before you go home. Make sure that you understand exactly what you need to do.

The PN solution and supplies will be delivered to you at home by a "home infusion company." They will give you instructions for how to care for and use the supplies. The PN solution comes in a bag you connect to the CVC. You will also work with a "home health agency." A home health agency has nurses who can teach you how to give yourself PN. They can help answer any questions you might have.

Before you give yourself PN, you should know:

●The type and amount of PN solution to give – Make sure that the PN solution has your name on it. Check that the "use by" date has not passed. Make sure that the total amount of liquid in the bag matches the amount on the label. For example, if the label says "1500 mL," make sure that the solution is at the 1500 mL mark on the bag. If the bag has more or less solution than the label says, call your doctor or nurse.

●When to feed yourself – Your doctor or nurse will tell you how often to give yourself PN. Many people do this during the night. This is often most convenient since it can take 10 to 12 hours, or sometimes longer, to give 1 bag.

●Whether you need "lipids" – Some people who get PN also need to get "lipids." Lipids are a type of fat the body needs to work properly. For PN at home, lipids are usually mixed into the PN solution and given every day or once a week. Your doctor or nurse will tell you if you need lipids and how to give them.

The general steps to give yourself PN are:

●Wash your hands (figure 1) – Always wash your hands before touching the CVC, PN bag, or other supplies. You might need to wash your hands a few times as you give yourself the PN.

●Take 1 of the PN bags out of the refrigerator – Put it on a clean surface that has been washed with soap and water. Do this 1 to 2 hours before the feeding, so that it can warm up to room temperature. Never heat the PN bag.

●Check the PN bag:

•Make sure that your name is on it and that the amount on the label matches the amount in the bag.

•Check the "use by" or "expiration" date. Never give yourself PN solution that is past the use by or expiration date. This can lead to infection.

•Gently squeeze the bag to check for leaks.

•Make sure that the PN solution is the right color and does not have anything floating in it. If the solution has lipids, it might look a little cloudy. If it does not have lipids, it should be clear. If you have any questions or if you are not sure if the PN solution is OK to use, call your doctor or nurse.

If the PN solution has the wrong information on it, has expired, leaks, or looks wrong, throw it away and use a different PN bag. Tell your home infusion company right away if you had to throw a bag away.

●Gather the supplies – This usually includes the PN bag, a pump, any "additives" (such as vitamins or medicines), tubing, syringes (including needles), gloves, and alcohol pads. Prepare and give your PN solution away from any distractions, because it is important to be very careful.

●Give the feeding based on your doctor's or nurse's instructions. The exact steps vary depending on the brand of the PN bag and pump. But in general, you will:

•Add the additives to the PN bag, if needed – You will use a syringe with a needle to get the additives from each vial (bottle) and then push them into a "port" on the PN bag. Scrub the top of the additive vial and the port with an alcohol pad first, and let them air dry. Double-check the dose of additives before doing this.

•Connect the tubing that you were given to the PN bag.

•Prepare the pump – The pump is the machine that actually causes the PN solution to flow from the bag into your body. Follow your home infusion company's instructions for how to clean, prepare, and connect tubing to the pump.

•Follow steps for "priming," if needed – Priming is a process that clears air out of the tubing before it is connected to the CVC. Your doctor, nurse, or home infusion company will tell you if you need to do this, and what steps to take.

•Give the PN solution – Connect the PN bag to the pump. Turn the pump on. The pump will run until the right amount of PN solution has been given. It has an alarm that will go off when it is done. Many home infusion companies give you a bag or backpack that you can put the pump and PN solution bag in. You can sit the bag on a table near you while you get the PN solution. If you need to get up while you are getting the PN solution, be very careful not to trip or pull on the tubing.

●Disconnect the PN bag and pump – After giving PN, flush the CVC using a prefilled syringe and clean your pump. Your doctor, nurse, or home infusion company will show you how to do this.

What else should I know?

●If you run out of PN solution, or if you have a problem with a PN bag, call your home infusion company. They will help you get more PN solution. Tell them if you are completely out of PN. Never skip a PN feeding unless your doctor or nurse tells you to.

●While you are getting PN, you might need to check your blood sugar level. Your doctor or nurse will tell you if you need to do this, and will teach you how and when.

●You might need to collect and measure your urine, bowel movements, or ostomy output (if you have an ostomy bag). This is to make sure that your body is not losing too much fluid. Write down the color of your urine. Your doctor or nurse will tell you if you need to do this.

●Weigh yourself once a week on the same day and at the same time. If you notice a weight gain or loss of 3 to 5 pounds (1.4 to 2.3 kg) in a week, it might mean that your body is holding onto or losing too much fluid. Call your doctor right away if this happens. They might need to change your home PN solution.

●You will need to get lab tests to check if you are getting enough nutrition from the PN, and to check for other health problems. Your doctor or nurse will let you know how often you will need to do this.

●Take care of your mouth and teeth, even if you are not eating and drinking by mouth. Brush your teeth every day, and floss regularly.

When should I call for advice? — Call your home health agency for advice if you:

●Have problems giving yourself PN

●Have problems with the CVC

●Had to throw a PN bag away

●Need more PN

Call your doctor or nurse for advice if:

●You have signs of an infection. These include:

•Fever of 100.4°F (38°C) or higher, or chills

•The skin around your CVC becomes red or swollen

●You have signs of an allergic reaction. These include:

•Rash, hives, or itchy skin

•Trouble breathing or swallowing

•Swelling of your mouth, face, lips, or tongue

●You have signs of fluid loss. These include:

•Not needing to urinate, or urinating only a small amount

•Dark urine

•Dry mouth or dry tongue

●You have signs of high blood sugar. These include:

•Needing to urinate more than usual

•Feeling more thirsty than usual

•Feeling tired, or having no energy

•Breathing fast, or having "fruity-smelling" breath – This can be a sign of a medical emergency called "diabetic ketoacidosis."

●You have signs of low blood sugar. These include:

•Sweating

•Shaking

•Confusion

•Fast heartbeat

●You have other symptoms, including:

•Tingling feeling in your hands or feet

•Swelling of your hands or feet

•Seizures

•Loose or hard stools

•Memory loss or confusion

•Yellowish skin, or the whites of your eyes turn yellow

•Belly pain

•Itching

•Gaining or losing weight in a short amount of time

•Changes to your hair, skin, eyes, mouth, or nails

More on this topic

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Patient education: How to care for a central line catheter (The Basics)
Patient education: Central line infections (The Basics)