Parenteral nutrition

Parenteral nutrition solution is a fluid that contains all the important nutrients your child needs to stay healthy. 

These can include:

• protein
• carbohydrates
• fat
• water
• vitamins
• minerals
• electrolytes.

The solution is given straight into your child’s bloodstream to make sure their body receives the nutrition it needs.

A parenteral nutrition solution is a mix of two different liquids.

1. White liquid containing fat
2. Clear liquid containing:

• glucose
• protein
• vitamins and minerals
• fluids.

The Parenteral nutrition solution bags are hung on a metal pole with wheels, called an IV pole. The bags are connected to an infusion pump.

An infusion pump is a small machine that makes sure the right amount of parental nutrition solution is pushed through the CVAD at the right speed. The infusion pump is attached to the IV pole and connects to your child’s central venous access device (CVAD).

A CVAD is a thin plastic tube inserted into one of your child’s larger neck or chest veins close to the heart. The infusion pump pushed the parenteral nutrition solution through the CVAD straight into the bloodstream.

A few different types of CVADs can be used, depending on how long your child needs parenteral nutrition. Your child’s doctor will talk to you about the best kind of CVAD to use for your child’s treatment.

CVADs are inserted into your child's vein so fluids can be delivered to the bloodstream over a period of time. 

Any type of tube that is placed in a vein has a risk of causing:

• infection
• inflammation of the veins
• blood clots.

Your child's treatment team will check regularly for things like:

• wet or dirty CVAD dressings
• leaks from the CVAD tubing
• high temperature
• red, swollen or hot skin around the CVAD
• discharge around the CVAD
• sweating
• shivering or shaking
• swelling in the face
• pain during feeds
• chest pain
• trouble breathing.

Let the nurse or doctor know if your child has any of these signs or symptoms as soon as possible.

Your child should be able to move around with their IV pole while receiving parenteral nutrition. They will need to take care not to trip or pull on any of the connected tubes and wires.

Your child will be able to have a bath or shower during periods when they are disconnected from the infusion pump and IV pole.

You will need to make sure the dressing covering your child’s CVAD is always kept clean and dry to prevent infection.

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 without support.

Let your child’s nurse or doctor know when the CVAD dressing becomes wet or dirty.

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

Checks can include:

• blood tests to check blood sugar, salt levels, kidney and liver function
• urine samples 
• tracking body weight
• tracking the amount of fluid your child has and how much urine they pass
• tracking temperature, blood pressure and pulse
• checking the CVAD dressing and skin for signs of infection.

Refeeding syndrome is a condition that happens when feeds are given too quickly after a long period of not getting enough nutrients.

When nutrients are introduced too quickly, the levels of fluids and electrolytes can change quickly and cause serious issues like:

• seizures – sudden, uncontrolled changes in movement or consciousness
• heart failure – when the heart stops working as normal
• comas – where a person is alive but in a deep state of unconsciousness.

If your child has not eaten or eaten enough for a long time before parenteral nutrition feeds are started, they will need to be given slowly. This is so their body can safely adjust to having enough nutrition again. 

Depending on your child’s specific needs, parenteral nutrition can be used:

• at the same time as eating through the mouth
• at the same time as using a feeding tube
• as the only source of nutrition.

Parenteral nutrition feeds can stop feelings of hunger and thirst in some children. If your child is still feeling hungry and thirsty, let their treating team know as soon as possible.

Your child might also have a dry mouth during feeds, so brushing their teeth and using mouthwash regularly is important.

Your child will go to the toilet, even during parenteral nutrition feeds.

Your child should be able to urinate regularly, but their poo will look different. Poo from parenteral nutrition is made up of mucous, cells and bacteria from the bowel and will be closer to liquid.

Parenteral nutrition feeds should not cause vomiting, tummy pain, diarrhoea or constipation. If your child has any of these symptoms, let the doctor or nurse know as soon as possible.