Parenteral nutrition factsheet

Introduction

When your child eats, their stomach and intestines break down food and absorb nutrients into the bloodstream. The stomach and intestines are part of the digestive system.

Some children have issues with their digestive system, including:

being unable to eat by mouth
being unable to digest food given through a tube into the stomach or bowel
needing to rest their digestive system after illness or surgery.

These children need a different way to get the nutrition they need to grow and stay healthy.

Parenteral nutrition (PN) is when your child is fed using fluids through a vein. This fluid contains all the nutrients your child needs, including:

protein
carbohydrates
fat
water
vitamins
minerals electrolytes.

The length of time your child needs PN depends on their condition.

Preparing for the treatment

Before starting PN, your child will need to have:

height and weight measurements
head circumference measurement if they are under two years old
a nutritional assessment by a dietitian
baseline blood tests
a central venous access device (CVAD) inserted.

Central venous access device (CVAD)

A CVAD is a thin plastic tube inserted into one of the larger veins in your child's neck or chest, close to the heart.

There are different types of CVADs, including:

The type of CVAD used will depend on how long your child needs PN.

During the treatment

PN solution is made up of two different liquids:

white liquid that contains lipids, also known as fat
clear liquid that contains glucose, protein, vitamins, minerals, and fluids.

The PN solution bags are hung on an IV pole, a metal pole with wheels. The bags are connected to an infusion pump attached to your child's CVAD. The infusion pump controls the amount of PN solution and the speed at which it is given.

Your child can move around with their IV pole while receiving PN. They will need to be careful of the tubes connected to their CVAD.

After treatment

The PN treatment can be stopped once your child can eat and drink either by mouth or through a tube. The amount of PN solution your child gets will slowly reduce as their digestive system gets used to food again. This process is called weaning.

After the treatment, your child's blood sugar levels will be checked, and the CVAD can be removed if it is not needed for any other treatments.

Management

Health checks during treatment

Your child will have regular checks to make sure they are healthy and getting the right nutrition from PN.

Health checks will include:

blood tests to monitor
blood sugar
liver and kidney function
electrolyte, vitamin, and mineral levels.
urine samples
tracking body weight
tracking how much fluid your child takes in and how much urine they pass
tracking temperature, blood pressure and pulse
checking the position of the CVAD
making sure there are no infections around the CVAD.

Eating and drinking during treatment

Depending on your child's specific needs, PN can be used at the same time as eating through the mouth or using a feeding tube. Some children may use PN as their only source of nutrition.

PN can stop some children's feelings of hunger and thirst because they are getting all the nutrition and fluids they need. Let your child's treatment team know if they are still feeling hungry or thirsty.

Your child's mouth may also feel dry, so it is important to brush their teeth regularly.

Toileting during treatment

Your child can still do a poo even though they are not eating food. PN poo is made up of mucous, cells and bacteria. The poo might be softer or more like liquid.

Your child's bladder should work normally during PN, and they should be able to pass urine or wee regularly.

PN should not cause issues like:

diarrhoea – runny poo that is difficult to control
tummy pain
vomiting.

Let your child's treatment team know if they have any of these symptoms, as they could be a sign of illness.

Showering during treatment

Your child can have a bath or shower while receiving PN.

Make sure your child:

keeps the CVAD and tubing out of any water
covers the CVAD and tubing with plastic clingwrap and tape when showering
has a sponge bath if they cannot sit up in a tub on their own.

To prevent infection, the CVAD dressing must always be clean and dry. Let your child's treatment team know as soon as the dressing becomes wet or dirty.

See the Bathing and showering with a CVAD information sheet.

Risks and complications of treatment

CVAD complications

Complications with the CVAD can include:

infection
dislodgement
blood clots.

The treatment team will closely monitor your child to manage these risks. Please let them know if you notice signs or symptoms like:

a wet or dirty CVAD dressing
leaks from the CVAD tubing
higher body temperature or sweating
red, swollen, or hot skin around the CVAD
discharge around the CVAD
shivering or shaking
swelling in the face
chest pain
shortness of breath or trouble breathing.

Refeeding syndrome

Refeeding syndrome is a condition that can happen when a child is reintroduced to nutrients too quickly after not eating well for a long period. Electrolyte and fluid levels can shift quickly and cause severe health issues.

Your child will be monitored with regular blood tests, and their PN can be started slowly to give their body time to adjust to good nutrition levels.

Liver abnormalities

PN can affect the liver in some children. This is monitored with regular blood tests and changing the PN solution as needed.

High or low blood sugar levels

PN solution contains a lot of sugar, which can raise blood sugar levels. If PN is stopped suddenly, blood sugar can drop quickly.

Your child's blood sugar levels will be checked regularly to monitor and manage this.

Fluid overload or dehydration

Fluid overload happens when the body gets too much fluid, causing swelling, difficulty breathing, and high blood pressure.

Dehydration happens when the body doesn't get enough fluid, causing issues like less urine, tiredness, and dizziness.

Both fluid overload and dehydration can cause severe illness if not managed.

To make sure your child is getting the right amount of fluid, you will need to monitor:

how much fluid your child is taking in
how regularly your child passes urine or poo.