› Administer Hyperalimentation

The "How To" of Hyperalimentation

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Most of you know this procedure as TPN (Total Parenteral Nutrition). It is a pretty straightforward procedure that does not require sterile technique except for a few particular items. While I have seen some facilities require everything from sterile gloves to masks, generally those are not part of an agency's SOP. 

I remember many years ago, my first bag of TPN had to be mixed under a laboratory hood to try to prevent contamination. I haven't seen that done in years. Perhaps the portion of the TPN that is now done in the pharmacy is done in that matter. 

Hyperalimentation Setup

The only parts that must remain sterile are the needle on the syringe, the cap where the needle is inserted the spike, the insertion port for the spike and of course the IV line cap to the patient. Once set up, nothing that can be handled is sterile.

Most home care patients are given a backpack to carry the TPN bag and the CADD pump so they are completely mobile. And while the nurse in this video was fortunate enough to have a CADD pump key, most of the rest of us use a penny to lock the cassette to the Card pump. Be kind and tape the penny to the back of the pump so that the next nurse to change the TPN bag has it handy. 

Total Parenteral Nutrition is meant to be refrigerated until needed. Take it out a few hours before it is needed for infusion. DO NOT microwave or put in hot water!! Here is more info on that.

Additional TPN information

While this video states parenteral nutrition is clear, that is not necessarily the case as you saw in the previous video.

Obviously in home care, there will be no second RN to verify the ingredients in the  TPN bag. So the clinician in the home must do this solo. Also watch the CADD pump settings to make sure that they are consistent with the orders. It may take a while getting through each and every ingredient, but better safe than sorry.

Another issue is to make sure you do not change the bag while the battery is removed. If you do, the pump will not know that the bag was changed and won't ask if you want to reset the reservoir amount. Then it will start beeping saying it is empty when in fact there is most of the bag left to infuse. 

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