How TPN/HPN is Administered
NEC UK Trustee Team member Claire has shared with us her daily journey caring for her TPN Dependent son Charlie.
This is Charlie's Central Venous Line (CVL) Catheter for the administration of Home Parenteral Nutrition.
TPN is normally given through a large central vein, there are various access points on the human body, as you can see from image one A CVL catheter is inserted into the vein in the chest just below the nipple. The placement is done in an operating room under sterile conditions to decrease the chance of infection. Several different types catheters are used based on the reason TPN is needed and the expected length of treatment. CVL Catheters are made of silicone and once the catheter is in place, a chest x ray is done to make sure the placement is correct.
Here is a short clip of Claire setting up Charlie's HPN under sterile conditions.
Central Line Care
Due to the nature of Charlie's condition we know he will rely on his Central Line long term, therefore it is highly important we take extra care in protecting it.
He is high risks for an infection, a blood clot in the line, a blockage or tare/break in the line. Should any of these happen we have protocols in place and are advised to seek medical attention straight away.
When we are not using Charlie's central line there is a small risk of it becoming blocked therefore to stop this from happening we flush the line and lock it with 2.5ml of Tarolock, we do this daily post his TPN feed.To also reduce the risk of infection he has a green bung placed on the end which is changed daily to reduce the risks.
To protect the site Charlie has a bath every other day where we change all of his dressings in a sterile environment.
To also reduce the risk of an infection we use a Biopatch around his Central Line, is a polyurethane foam disc infused with chlorhexidine gluconate (CHG). The Biopatch is effective against a variety of gram positive and gram negative bacteria (Bhende and Spanglar, 2004).
The device provides a steady release of CHG around the insertion site over a 7 day period The sponge nature provided by the foam disc keeps the site clean and dry whilst still releasing CHG. According to Timsett a Biopatch has been shown to reduce the rate of central line infections up to 69% (Timsett et al, 2009).
A short video of Charlie's Central line Dressing Change
If you wish to follow Charlie's Journey head over to his Family Story