Home parenteral nutrition (HPN)

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What is Home Parenteral Nutrition (HPN)?

HPN is a way of giving all nutrients (protein, fat, carbohydrates, electrolytes, vitamins and minerals) directly into a central vein in the body at home. At home, parents and caregivers can take on some or all of the responsibility for the CVAD (Central Venous Access Device). How much responsibility parents and caregivers take on will depend on their level of comfort with this role. With teaching and support, parents and caregivers can learn to take care of the CVAD, and safely give HPN through it.

Why does my child or youth need 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.

Care partners

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.

What does the PN solution contain?

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.

How do I give PN at home?

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).

Who will prepare the PN solution?

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.

HPN tips

• 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.

Storing PN solution

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.

How do we store other supplies?

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