What is Home Parenteral Nutrition (HPN)?

Your child or teen may not be able to eat enough to grow and be healthy. Sometimes, the stomach and intestines cannot absorb enough nutrients from food for growth and health. Your child or teen may have started PN while in hospital, but can continue this treatment at home.

As you learn to care for your child’s CVAD and give HPN, you’ll need to have someone at home to support you. This care partner should be easily available to help you when needed. Your care partner will also need training to care for the CVAD, and to give PN through it. The community health nurse will teach you how to operate the IV pump, and work through any problems that come up.

The PN solution contains:

• Protein: an important part of all living tissue, and is made up of smaller building blocks, called amino acids. Amino acids are needed for growth, healing and fighting infections.
• Carbohydrates: these nutrients break down in the body to simple sugars, like glucose. Glucose is the only sugar found in the blood for any length of time.
• Fats: a concentrated form of energy. Using fat in PN gives more calories in a small amount of fluid. It also supplies essential fatty acids, which cannot be made in the body. Fatty acids help develop nerve cell structure; affect blood-clotting time; and play an important role in the breakdown of cholesterol. Lipids are the white IV solution.
• Electrolytes: nutrients (for example: such as calcium, potassium, phosphorus, magnesium, sodium chloride and acetate)  needed for bone, nerve, organ and muscle function.
• Water. The amount of water in the PN depends on your child or teen’s height and weight. PN nutrients are combined in 1-3 liters of water in a germ-free (sterile) plastic IV bag.
• Multivitamins. Your doctor will decide what vitamins your child or teen needs. Multivitamins are added to the PN solution just before you start the PN infusion. They are only stable for a certain period of time. The Community Health Nurse will teach you how to draw up the vitamins with a syringe and inject them into the PN IV bag. The PN solution will turn yellow after the multivitamins are added.

Your doctor, dietician and pharmacist will decide on the nutrients and amount of PN solution your child or teen needs. They’ll also tell you how long to run the infusion.

Most of the time, PN is given over 10 to 16 hours, through the evening and night. This allows children and youth some freedom during the day. It’s important to start and stop the infusion at the same times each day. The total number of hours and amount of PN solution given must stay the same (unless your doctor changes it).

The specialty compounding pharmacy will prepare the bag of PN solution. The pharmacy will also deliver it to your home, along with all the other supplies you’ll need. This will include a small, portable IV pump. Toddlers or preschoolers will have a backpack for their IV pump. School age children and teens will have a fanny pack for their pump.

• Do not use the IV bag if the fluid is cloudy or if you see particles floating in it. Stop the influsion if floating particles appear during the infusion. Replace the bag with a bag of clear, particle free IV solution.
• STOP! Do not heat PN, or allow it to freeze.
• Check the expiry date and do not use if beyond the expiry date.
• Check the PN bag to make sure the fluid is clear. You should not see any particles floating in the solution.
• Precipitates (floating particles) can happen anytime during the infusion, especially if the bag is exposed to things like too much heat or light. Check the PN solution often during the infusion for floating particles.
• Flush Port-a-cath with 0.9% Sodium Chloride. If your child’s CVAD is a Port-a-cath, you will need to flush it with 20 mL of 0.9% Sodium Chloride each day. This will prevent PN solution from building up in the port chamber.

The specialty compounding pharmacy will bring you a supply of PN solutions and medications every week. They will also bring you a medication fridge to store everything. To prevent infections, do not store any food items in the medication fridge. You must use up the PN solution within 24 hours after taking it out of the fridge.

Keep all other supplies in a clean, dry place, away from children and pets.