What does TPN even look like?

HELLLOOOOO!

Long time no write, y’all. Sorry about that. I had a very very rough few months from August till November. It was all one little pesky infection that made it’s way to my central line and into my lungs after not being tended to for so long. It was very unfortunate and included three admissions (does not include additional ER visits) to my local hospital, and one final hoorah at my big hospital in Dallas after the local doctors really made a mess of it and somehow didn’t catch that it was an infection. Even with unclear cultures they deemed “contaminated” about 883 times, persistent yet random fevers (even up to the 103 range) and all kinds of symptoms that yelled infection.

But that’s all said and done and I am cleared from my blood and lung infections after a month of IV antibiotics and a new central line placement. And I am back!

bye
bye bye old Hickman 😦
new line new me
new line, new me

All I’ve got to say is thank goodness for good friends. Those who help you celebrate Halloween inpatient, play games with you, come to chat, and bring you a puppy to love on in the hospital! jojopuppy

I have pondered the idea of how interested friends are to see me set TPN up for the first time. I realize I’ve seen this process since I was thirteen years old, and it is literally an every day rodeo in my life. But for those not living this life, they have NO idea what the heck this could even begin to look like.

So I’m going to share with you today! I’ll write out some descriptions of what is happening in each photo, but this will be a very photo heavy post. So let’s hop to it!

It all starts with a trip to my mini fridge! We store my TPN bags in a little fridge that is only used for TPN in Anthony’s closet. This is also where my stickers go.

tpn set up03917Web

Here they are hanging out in my mini fridge! This is only 3 days worth of TPN. It is a full house on shipment day with 7 days worth!tpn set up03921Web

I grab the kind of bag I need that day (there are lipid bags that contain SMOF lipids which are my fat source, and there are “clear” bags that are the same formula, just without the fat source!) and lay it, along with the two vials of vitamins, out several hours before infusion time so that it can warm up to room temperature.

tpn set up03928Web.jpg

Around 9 PM, I set the rest of it up!

First and foremost, I WASH MY HANDS and DRY WITH A CLEAN TOWEL/PAPER TOWEL. (Sorry not sorry for the caps lock there 😉 )

Then I get the rest of my supplies for the night out.

This includes:

  • 2 vials of vitamins
  • 2 saline flushes (sterile salt water)
  • 1 heparin flush (flush that helps prevent blood clotting)
  • 1 empty 10ml needled syringe
  • alcohol swabs
  • my infusion pump
  • backpack
  • (my bags come pre-spiked, meaning the tubing is already in my bags before I get them, this is not always the case and is generally an additional step in the process)

I keep my supplies stored in a little basket by my bed in little baggies that have the supplies needed for each night! (This is an old photo of where the baggies live, I use a pump that has a lithium battery that recharges now, so no more batteries!) The top shelf is where the nightly supplies live, the bottom shelf is where my dressing supplies live (that happens weekly, and I’ll be sharing that process soon!)

Organization00562Web
Top Shelf: daily supply “kits.” Bottom Shelf: dressing change supplies.

tpn set up03930web

Next, I place the heparin flush and one of the saline flushes in the pocket of my backpack for the next morning when my infusion is done (I do not unwrap these, they’re just unwrapped in the photo!)tpn set up03934Web

Then I add the vitamins to my bag. They must be added right before infusion because otherwise they will go bad in the bag if they’re hanging out in there for a week while sitting in my mini fridge.

First, I flip the cap off of one of the vials, then swab it with alcohol for 30 seconds. tpn set up03940Web

Then draw up the solution into the empty syringe.tpn set up03942Web

Do the same steps with the second vial, and put the solution into the same syringe (it’s a two part vitamin solution that has to be mixed right before infusion as well!)

Then I have my 10mls of vitamins and swab the port on the end of my TPN bag where I swab for 30 seconds with alcohol before administering the solution into the bag.tpn set up03943Webtpn set up03944Webtpn set up03948Web

Then I throw the needle syringe into my Sharps container! Bye stabby things!tpn set up03952Web

I then gently mix my bag (note *gently*) It magically turns the bag yellow! (Too bad this wasn’t a lipid night where I could show you the fun part of mixing the lipids in! They’re white, so those bags look very milky once it’s all mixed together.)tpn set up03955Web

Next, I put the tubing into my pump! It fits in there like a little cassette type situation.tpn set up03953Webtpn set up03954Web

Then I flush my central line and leave the syringe on until I’m ready to connect the TPN bag to me!

P.S. I personally do not use gloves for this process, this was taken right after I had done something that I needed gloves for and I forgot to take them off! (You can even tell these are on different days because I’m not even wearing the same clothes! Whoops!) I use my very clean hands. Everyone has very different protocols for this process though. Do what your care team tells you if you are on TPN!dressing change and tpn start04104Web

I then turn my pump on and let it go through it’s program, then prime the tubing (this means letting the liquid get all the way through the tubing so that I’m not infusing air into my body!) dressing change and tpn start04108Web

When it’s all primed, the TPN will drip a few drops into a trash bag (if you are new to TPN, here’s a pro tip from someone who was young and dumb, TPN is sugar, sugar stains carpet, don’t prime your tubing onto carpet. You’ll see the stains a year or two later! Sorry, dad!)dressing change and tpn start04124Web

Then I unscrew the empty saline syringe and immediately screw on the end of the tubing to the TPN bag to my central line (this is the one that goes to my heart.)dressing change and tpn start04133Web

And press START!dressing change and tpn start04144Web

Then it runs overnight while I’m sleeping for 12 hours. I simply place my backpack by my bed on the floor. It’s what I’ve always done, and it’s always worked well for me! Some hang their bags on an IV pole, hang it on a hook type situation, different things for different folks!

Apparently I took these photos over several days! (Yes, these are a little old, I’ve been meaning to post this for a few months 😉 ) Cause lookie here! This is an empty lipid bag! That’s the milky white fat source bag. See it in there?

Anyway, this is the morning after an infusion. I grab the saline and heparin flushes that I put in my backpack the night before, grab alcohol swabs, along with an alcohol cap (I wrote more about those cuties here).

tpn start and trash03864web

First, I unscrew the end of the tubing from my central line, scrub the hub with alcohol, and flush with a saline flush.tpn start and trash03877Web

Then do a heparin lock flush.tpn start and trash03882Web

Then cap it off with the SwabCap! tpn start and trash03887Web

And put my cute little pump on her charger for the day! And I’m all done until 9 PM that night!tpn start and trash03870Web

(Not so) fun fact, this is how much garbage a night of TPN produces: tpn start and trash03898Webtpn set up03906Web

Nuts, right?

Anyway! That’s how that works and what it all looks like! If you have any further questions, I’d love nothing more than to help try and answer them!

I’ll see you around here again soon!

Let me know if there are any things you’re curious to hear about, I love writing about things people are curious about!

 

6 thoughts on “What does TPN even look like?

  1. Beautiful visual post, Lauren! This is a great tool to share with our patients. Is that okay?
    Thanks again for sharing! ♥
    Susan from Diplomat/ThriveRx

    Liked by 1 person

  2. Hello Lauren,

    Love what you are putting out. Possible to share on our Social Media? We would link to you of course.

    Happy Friday!

    Best,

    Gibran Maciel
    President / CEO
    SBS Cure Project
    sbscureproject.org
    (916) 634-9978
    Seeking a Cure for Short Bowel Syndrome

    Like

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