Dressing care basics

• Dressings are usually changed every 7 days, or sooner if they become wet, loose, or soiled
• The site should stay clean, dry, and fully covered
• Aseptic technique (steps used to reduce germs and contamination) must be used during every dressing change, including careful hand hygiene, the use of sterile dressing supplies, and proper handling to avoid contamination.

Why this matters

Central line flushing basics

• Flush before and after infusions or medications
• Use saline and sometimes heparin, if prescribed
• Use the push-pause method (a gentle start-and-stop flushing technique) as taught by their nurse

Why this matters

Why is a central line needed for TPN?

• TPN is a very concentrated medication. It cannot safely be given through a regular IV.
• Large central veins have strong blood flow, which helps dilute the TPN as it enters your bloodstream.
• Central lines are also designed for long-term use and can remain in place for months or even years.

Common types of central lines

• PICC -  placed in a vein in the arm
• Tunneled line – placed under the skin and connected to a large vein (often called by brand names such as Hickman®, Broviac®, or Leonard®)
• Implanted port – placed under the skin and accessed with a special needle
• Your provider will determine which type is best for your medical needs.

What this means for you

Yes, children, including infants, can receive TPN when their bodies are not able to absorb enough nutrition through the digestive system.

When TPN is used in children

TPN may be needed for:

• Short bowel syndrome
• Congenital or acquired intestinal conditions
• Severe motility disorders

How care is tailored

Care for children on TPN is adjusted to support growth and development.

This may include:

• Careful adjustment of nutrition as the child grows
• More frequent lab monitoring
• Coordination between specialists, caregivers, and the pharmacy team

Why this matters

With proper support and monitoring, TPN can help children receive the nutrition they need to grow and develop safely.

Bone health is monitored through a combination of lab testing and imaging over time.

Lab tests

Your care team may check:

• Calcium, phosphorus, and magnesium
• Vitamin D levels
• Parathyroid hormone (PTH), which helps regulate calcium

These tests help identify imbalances that can affect bone strength.

Imaging tests

Bone density scans (DEXA scans) may be used to measure bone strength.

These are typically done every 1 to 3 years depending on your risk factors and medical history.

How monitoring helps

Bone loss can happen gradually without symptoms. Regular monitoring allows your care team to identify changes early and adjust your treatment plan if needed.

Lipids are an important part of TPN that provide fat, calories, and essential fatty acids your body needs for energy, cell function, and overall health.

Types of lipids used in TPN

There are several types of lipid emulsions that may be included in your TPN:

• Soybean based lipid emulsion: A traditional lipid option commonly used in TPN
• Blended lipid emulsion: A lipid option that may contain soybean oil, medium chain triglycerides, olive oil, and fish oil
• Specialized fish oil lipid emulsion: A lipid option with restricted use for certain medical conditions

Each formulation has a different balance of fats. Your care team selects the type and amount of lipid based on your lab results, liver function, medical history, and overall nutrition needs.

What lipids do in the body

Lipids help:

• Provide a concentrated source of calories
• Support brain and nerve function
• Maintain healthy cell membranes
• Deliver essential fatty acids your body cannot produce on its own

Some patients receive lipids daily, while others may receive them on a different schedule depending on their treatment plan.

Why this matters

Lipids are a key part of your nutrition plan. Too little or too much can impact your health, so your care team monitors your labs closely and adjusts your TPN formula as needed.

Long term TPN can affect bone health in some patients, although it does not happen to everyone.

Why can bone changes happen

Bone health may be affected by:

• Imbalances in calcium, phosphorus, magnesium, or vitamin D
• Reduced nutrient absorption through the digestive system
• Certain medications or limited mobility

Changes in how the body processes these nutrients over time can affect bone strength.

What to expect

These changes often develop gradually and may not cause symptoms right away. In some cases, patients may experience bone pain or an increased risk of fractures.

Why this matters

Your care team monitors your lab values and adjusts your TPN formula to help maintain proper nutrient balance and support bone health over time.

In many cases, yes, you may still be able to eat or drink while on TPN. This depends on your condition and how well your digestive system is working.

How it varies by patient

Some people on TPN:

• Eat small amounts of food for enjoyment or additional nutrition
• Drink fluids if it is safe for them
• Rely entirely on TPN if their body cannot absorb nutrients

What your care team considers

Your care team will guide you based on:

• Your diagnosis
• How much your body can absorb
• Your nutrition and hydration needs

They may also consider whether eating causes symptoms such as pain, nausea, or diarrhea.

Why this matters

Your nutrition plan is individualized to support your health while avoiding complications. Always follow your provider’s recommendations about what is safe for you.