This is how I setup my TPN session
Supplies needed for a night of TPN: Tubing, Alcohol wipes, 2 new syringes, Vitamin vials, TPN bag, Blue mat
Time to clean the vials and ports that will come in contact with my line.
*You MUST scrub for 15-30 seconds for every new connection*
I do this for both vials and the TPN bag port at the same time since I just find it easier once the syringe is drawn.
Quite exciting, I know.
Now to draw up the vitamins from the vials. You first pull the plunger back to the amount of liquid needed from the vials to fill the syringe with air. I need 5mL of vitamins from each vial, so I take 5mL of air.
I then insert the syringe needle and invert the vial and push the air into the vial. Since the vial is already full, it will displace the air I pushed in, with liquid vitamins into the syringe.
For the most part it will fill itself up to the 5mL line but sometimes you will need to pull back on the plunger to get the rest of your vitamins into the syringe. Keep in mind that the needle will also need to be pulled back as you replace air for liquid, otherwise you will get bubbles in your syringe and need to start over.
To do the next vial, it is the same routine. Pull in 5mL of air into the syringe again even with the extra 5mL of liquid. The plunger will just be at 10mL instead of 5mL.
Inject the vitamin mixture into the TPN bag carefully. If it isn’t straight, you can poke the needle through the side and straight into your finger or out of the bag, wasting the whole bag and hurting yourself in the process. Also, it is good to drawback some of the fluid from the neck of that port and flush it a few times to get all the vitamins out of the neck and into the bag. I do this until the liquid I draw is completely white.
Next is to pop off the top to the TPN bag. Keep in mind that it is sterile underneath so do it carefully, even though it is often quite difficult. Make sure your hands are clean.
The cap is removed from the end of the tubing and the bag is stabbed, also difficult. Again, keep your hands clean. This is all supposed to remain sterile as any bugs here go straight to your heart. Make sure the end gets all the way through; you’ll know when TPN starts to move through the tubing.
I cheat on priming and perhaps am not the best to teach this part, but I’ve learned after a few months doing this as this is how all my nurses did it when I was in the hospital all those times. If you take the bag and hook it on something high and leave the end low, the TPN mixture just runs right through. Easiest way to prime. I no longer use the pump as this takes like a minute. Just make sure to use the clamp once it reaches the end!
Sorry, my Ellie is always there, helping whenever possible – had to include her.
Programming the pump and hooking in the cassette.
Always accessed so it is always dressed. I get to deaccess it myself on Monday and I’ll see about getting a picture of it then before they reaccess it. It isn’t so cute because of all the rashes and scars from those rashes but the actual incision looks beautiful.
More scrub a dub dubbing, preparing to flush with saline before I can hook up to my TPN bag.
Short pumps of saline at a time help clean everything out; just one syringe is necessary.
TaDa! All hooked up. Whew!
In the morning, when it runs out, clamp everything and grab 2 saline syringes and a heparin syringe for flushing the TPN out. The heparin stops it from clotting off and goes in last. Then I’m free to go back to bed or do whatever. Not really a bad situation.
8 Responses
tom says...
hi kirby my name is tom i live in sacramento ca.Im on TPN like you 12 hrs at night. I like the idea of hanging the bag to prime it instead of holding the button.I have one question though about you doing it bare handed, no sterile gloves like we were tought. You dont get alot of infections doing it without gloves?
Kirby says...
I just use a lot of hand sanitizer, alcohol wipes and wash my hands. Here they didn’t have us using gloves. I haven’t had a single port inflection yet, so I suppose my practices seem to be working well. If you have the supplies and use gloves, go for it. Do what you need to feel comfortable
I had to bump my TPN up to 16 hours recently though as now I’m on 2000ml of TPN instead of 1600. I seem to be struggling with the increase in fluids. Guess it just needs more time.
Brittany says...
We’ve always hung the bag high and let the TPN run through, using gravity to prime. The pump takes way too long! That’s how we were taught, too. We’ve never used sterile gloves, and I’ve never gotten infections from outside sources. All of my infections are gastric bacteria and fungi from the colon and small intestines. We do go crazy with hand sanitizer.
Kirby says...
Same – I haven’t received any infections either. However now that I use that new backpack – I have to prime it differently. Like in the video, I have to hook the bag up while in the backpack and then I tried to gravity prime it, but it wouldn’t go. So I just lean on it to push it through. Still faster and easier than holding down that prime key! Love you Brittany!
Kailee says...
Tom, there is no way to set up TPN sterile so there is no reason to wear sterile gloves. The second you touch anything–your TPN bag, the vials of multivitamins, the outside of any package such as saline, syringe, etc, you’ve broken sterility.
Kirby, you did a great job of explaining! It’s very common to hang the TPN and let it prime itself, that’s how I do everything (TPN and IV fluids) and how it’s done in hospitals too. Actually, since I’m impatient, I actually squeeze my TPN bag to force it through the tubing faster ;o)
Thanks for a cool website!!
Kirby says...
Funny you mention having to squeeze the TPN through the tubing faster. This is how I must do it now that I use a different backpack. It requires me to hook up the bag while in the backpack and once it is setup in the backpack, gravity doesn’t work so well to prime the bag. So I lean over it with my elbows and watch TV as it goes through the tubing. Sometimes I forget to watch it, and a puddle of TPN ends up on the floor. No problem, my puppy, Ellie, loves the stuff and happily helps clean up any spills
Granted, she only helps with small spills. Who knows what that stuff does to a dog in larger quantities. I’d rather not find out =) Thanks for all the comments! I’m glad I can provide a place to help others with what is almost always overwhelming in the beginning. Happy tummy days!
Tzipora says...
Oh my gosh! I just happened to watch your video and feel compelled to like smack myself in the forehead and say “NO WAY!”… Why? Well first off I spent the first 5 months on TPN priming it with the darn pump (which I’ve timed, it takes exactly 5 freaking minutes!) then my current nurse showed me what we jokingly call the “magic button”. She had me force priming it by pushing on it and all but we were taking the little blue plastic part off and holding the tiny green piece underneath. So it kills your finger and you’ve got to hold onto it the whole time. I am like in disbelief right now that it could be even easier than what I’ve been doing! I’m literally wishing I could go prime tomorrows bag because I won’t fully believe it until I try. And I think I’m going to have to show my nurse! Haha. Thank you for this!
Kirby says...
Haha, yeah – I figured out this trick watching my own nurses while in the hospital. Took me ONE time of taking off the little blue clamp, to realize that was a no-no. It isn’t exactly taught this way but my finger hurts from holding down the prime button and I, for the life of me, can’t figure out why my pump lacks a self-prime button like the enteral feeding pumps do. It all seems to be the same deal. Oh well! To each their own. I’m glad I could be of some assistance to you with this process. Good luck and happy tummy days