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.

Each TPN vitamin or medicine will be tailored to your needs. Some medicines must be added to the TPN bag just before infusing. Add the vitamins or medicine to the TPN bag as you get it ready.

You will work closely with a nurse until you feel comfortable taking care of your catheter and giving yourself TPN.

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. Ask your healthcare provider or nurse for more information about caring for your catheter, using sterile technique, and flushing your catheter. There are additional sheets 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.

  • Rinse your hands with your fingers pointing toward the drain.

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

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

Step 2. Gather your supplies

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)

  • Medicine vials or multivitamin vials as prescribed

  • Special container to throw out the used needle and syringe (sharps container). 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 and lid.

  • Trash can

Step 3. Clean your work area

  • Take 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 cleaned and dried work surface.

  • Wash your hands again, using the steps for hand washing listed above.

  • If you ever need to sneeze, move away from your work surface.

Step 4. Get ready to inject

  • Remove the protective cap from the vial. Wipe the top of the vial with an alcohol pad.

  • Remove the cover from the needle.

  • Pull 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 draw from the vial. For example, if you need 10 mL of medicine, draw in 10 mL of air.

  • Insert the needle into the rubber top of the vial. Push air into the vial.

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

  • Be sure to keep the needle tip below the fluid level.

  • 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.

  • Carefully replace the cap.

Step 5. Inject solution into the bag

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

  • 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

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

  • Remove the needle.

  • Mix the medicine into the TPN solution by gently rocking the bag.

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

Step 6. Discard your materials

  • Don’t recap the needle after you have used it.

  • Throw the needle and syringe away in your sharps container. When the container is full, take it back to your healthcare facility for proper disposal.

  • 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 seek medical care

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 above 100.4°F (38.°C) or shaking chills

  • Redness, swelling, or warmth at your insertion site

  • Drainage or pus from your insertion site

  • Shortness of breath

  • Any chest pain