CHHS16/081
Canberra Hospital and Health Services
Clinical Procedure
Administration of Total Parenteral Nutrition (TPN) – Adults
and Children (not NICU)
Contents
Contents......................................................................................................................................1
Purpose.......................................................................................................................................2
Alerts...........................................................................................................................................2
Scope...........................................................................................................................................3
Section 1 – Before commencing TPN..........................................................................................3
Section 2 – Commencing TPN in Adults (Adult TPN solutions)...................................................4
Section 3 – Commencing TPN in Children (Paediatric and Neonatal TPN Solutions).................5
Section 4 – Monitoring TPN in Adults and Children...................................................................7
Section 5 – Disconnecting TPN in Adults and Children...............................................................8
Section 6 - Weaning and Cycling TPN.........................................................................................9
Section 7 – Home Parenteral Nutrition (HPN) – Patient Education and Discharge Planning.....9
Implementation........................................................................................................................11
Related Legislation, Policies and Procedures............................................................................11
References.................................................................................................................................12
Search Terms.............................................................................................................................13
Attachments..............................................................................................................................14
Attachment A – Information Regarding Suppliers of HPN....................................................15
Doc Number Version Issued Review Date Area Responsible Page
CHHS16/081 1 22/06/2016 01/07/2020 Medicine 1 of 15
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
, CHHS16/081
Purpose
The purpose of the Total Parenteral Nutrition (TPN) Clinical Procedure is to outline the
process for the safe administration and management of TPN in adult and paediatric patients
of Canberra Hospital and Health Services.
This clinical procedure provides information for nurses and midwives who care for patients
receiving TPN in the acute hospital and the community setting.
Parenteral nutrition is complex and only aspects of TPN administration and monitoring are
encompassed by this clinical procedure. Further clinical guidance in relation to parenteral
nutrition can be found in the NSW Agency for Clinical Innovation Parenteral Nutrition
Pocketbook: For Adults (refer to references).
This Standard Operating Procedure (SOP) describes for staff the process to
Scope
Alerts
All patients who are to commence TPN must have a Central Venous Access Device
(CVAD) in situ, that is a:
Central Venous Catheter (CVC)
Hickman’s line
Implanted port, or
Peripherally Inserted Central Catheter (PICC).
In adults: Prior to commencing TPN the tip of the CVAD must be confirmed to be at the
distal superior vena cava close to or at the cavoatrial junction. Confirmation is made
utilising fluoroscopy, Chest X-ray or ECG Tip confirmation technology.
In children: Prior to commencing TPN the tip of the CVAD must be confirmed to be at
the distal SVC. Confirmation is made utilising fluoroscopy or Chest X-ray.
If a multi-lumen CVAD line is in place, one lumen from the CVAD must be allocated
exclusively for TPN. In addition, when there is a multi lumen CVAD in situ, it is desirable
that the CVAD not be used for other purposes.
The TPN solution is light sensitive and must be covered with the supplied light protective
bag at all times.
TPN should be always be administered via a smart pump with infusion safety software.
Patients on continuous TPN must have the TPN bags and lines changed every 24 hours.
If a patient is on 16 hourly TPN infusions, the bags and lines should be discarded at the
end of each infusion. In paediatric patients, there are some cases where the TPN bag
Doc Number Version Issued Review Date Area Responsible Page
CHHS16/081 1 22/06/2016 01/07/2020 Medicine 2 of 15
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
Canberra Hospital and Health Services
Clinical Procedure
Administration of Total Parenteral Nutrition (TPN) – Adults
and Children (not NICU)
Contents
Contents......................................................................................................................................1
Purpose.......................................................................................................................................2
Alerts...........................................................................................................................................2
Scope...........................................................................................................................................3
Section 1 – Before commencing TPN..........................................................................................3
Section 2 – Commencing TPN in Adults (Adult TPN solutions)...................................................4
Section 3 – Commencing TPN in Children (Paediatric and Neonatal TPN Solutions).................5
Section 4 – Monitoring TPN in Adults and Children...................................................................7
Section 5 – Disconnecting TPN in Adults and Children...............................................................8
Section 6 - Weaning and Cycling TPN.........................................................................................9
Section 7 – Home Parenteral Nutrition (HPN) – Patient Education and Discharge Planning.....9
Implementation........................................................................................................................11
Related Legislation, Policies and Procedures............................................................................11
References.................................................................................................................................12
Search Terms.............................................................................................................................13
Attachments..............................................................................................................................14
Attachment A – Information Regarding Suppliers of HPN....................................................15
Doc Number Version Issued Review Date Area Responsible Page
CHHS16/081 1 22/06/2016 01/07/2020 Medicine 1 of 15
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
, CHHS16/081
Purpose
The purpose of the Total Parenteral Nutrition (TPN) Clinical Procedure is to outline the
process for the safe administration and management of TPN in adult and paediatric patients
of Canberra Hospital and Health Services.
This clinical procedure provides information for nurses and midwives who care for patients
receiving TPN in the acute hospital and the community setting.
Parenteral nutrition is complex and only aspects of TPN administration and monitoring are
encompassed by this clinical procedure. Further clinical guidance in relation to parenteral
nutrition can be found in the NSW Agency for Clinical Innovation Parenteral Nutrition
Pocketbook: For Adults (refer to references).
This Standard Operating Procedure (SOP) describes for staff the process to
Scope
Alerts
All patients who are to commence TPN must have a Central Venous Access Device
(CVAD) in situ, that is a:
Central Venous Catheter (CVC)
Hickman’s line
Implanted port, or
Peripherally Inserted Central Catheter (PICC).
In adults: Prior to commencing TPN the tip of the CVAD must be confirmed to be at the
distal superior vena cava close to or at the cavoatrial junction. Confirmation is made
utilising fluoroscopy, Chest X-ray or ECG Tip confirmation technology.
In children: Prior to commencing TPN the tip of the CVAD must be confirmed to be at
the distal SVC. Confirmation is made utilising fluoroscopy or Chest X-ray.
If a multi-lumen CVAD line is in place, one lumen from the CVAD must be allocated
exclusively for TPN. In addition, when there is a multi lumen CVAD in situ, it is desirable
that the CVAD not be used for other purposes.
The TPN solution is light sensitive and must be covered with the supplied light protective
bag at all times.
TPN should be always be administered via a smart pump with infusion safety software.
Patients on continuous TPN must have the TPN bags and lines changed every 24 hours.
If a patient is on 16 hourly TPN infusions, the bags and lines should be discarded at the
end of each infusion. In paediatric patients, there are some cases where the TPN bag
Doc Number Version Issued Review Date Area Responsible Page
CHHS16/081 1 22/06/2016 01/07/2020 Medicine 2 of 15
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
