Produced By Georgina Wright

4th Year Paediatrics SSM

Parenteral Nutrition and Your Child

An Information Leaflet for Parents

What is Parenteral Nutrition (PN)?

PN is a way of giving nutrition (food) to your child directly into their blood stream. It can be used to supply all necessary nutrients or it can be combined with oral or tube feeding.

Why does my child need TPN?

There are lots of reasons why children might need PN. The most common one is because their gut is not working properly and so they can’t digest the food they eat. There are lots of reasons why this can happen, for example premature babies and children who have had an operation on their gut. The doctor will discuss with you the exact reason why your child needs PN.

What is in TPN?

The food we eat consists of lots of different components – proteins, carbohydrates, fats, salts, vitamins, minerals and water. In PN these things are provided in an already digested form so the gut doesn’t have to break down food to get them. The nutrients, known as a feed, come in bags like a drip.

Help and Support

Lots of people are available to help if you have any queries or need to talk. People who will be able to help are

  • Your child’s Doctor
  • The Nutrition Nurse Specialist
  • The Dietitian
  • The Pharmacist who makes up the feeds

There is also a special support group:

P.I.N.N.T – A support group for Patients receiving Intravenous Parenteral or Enteral Therapy.

They provide support for children and adults who need nutrition therapy.

Contacts:

Ian Swain 01746 765721

Carolyn Wheatley 01202 481625

Email:

Your Child’s Social and Emotional Needs

As your child is unable to eat in the normal way we need to encourage them to use their mouths because it is important for development. This can be done by providing dummies and if possible different tastes and textures via the mouth. A Speech Therapist can get involved to help with this.

Your child may not be able to move around much when they are connected to their PN infusion but any movements and play they can manage are really important and should be encouraged.

If your child has been in hospital for a long time their development can be affected so lots of play, stimulating activities and contact with family is encouraged to make sure they develop normally.


How is PN given to my child?

The Catheter

PN is given in to the blood stream via a vein. A small tube called a catheter needs to be inserted. The type of catheter used is a Broviac line, these are central lines. Your child will need to be asleep (under anaesthetic) while it is inserted. A small cut is made in the skin and the catheter is threaded in through a large vein, usually in the neck. The tip sits just outside the heart.

This is a baby receiving PN via a Broviac catheter.

The Infusion Pump

The feed bags are connected to the catheter via an infusion pump which allows the PN to be delivered in to the blood stream at the right speed over the right amount of time.

Could there be any problems with the PN?

  • The most common problem is an infection with bugs getting in to the body, sticking to the catheter and making your child unwell. They may get a fever or vomiting and diarrhoea. These are signs of infection and will need to be treated with antibiotics.
  • The catheter can also get blocked which means the infusion of PN can’t be given. The catheter must be flushed after the infusion of feed is finished to help prevent blockage. The pump will know if the line is blocked and an alarm will sound, if this happens tell a nurseimmediately. There are lots of ways the catheter can be unblocked easily and the PN can be restarted.
  • If your child is on PN for a long time they can get a problem with their liver called Cholestasis, they may look jaundiced (yellow). Adding small amounts of oral feeding if possible can help prevent or reverse this condition, and it usually gets better as more milk feeds are given. There are also medicines that the doctor can give to help.
  • The balance of the nutrients in the body may not be right and this can cause problems for your child. For this reason the blood is tested regularly and any imbalances can be corrected.