Parenteral nutrition

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

Connecting parenteral nutrition/support (using a standard ANTT® approach)

Statement To ensure safe care and maintenance of catheter/device and maintain patency of catheter/device when connecting Parenteral Nutrition/Support.
Requirements
  • PPE (minimal considerations disposable apron)
  • Clean tray or trolley
  • Sterile sheet x 2 or dressing pack
  • 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
  • Parenteral Nutrition administration set.
  • Parenteral Support (PS) remove from fridge and hang for 1 hour before use.
Timing As required. Parenteral Nutrition should always be prescribed.
Procedure
  • Explain the process to the child and parent and gain consent.
  • Perform hand hygiene.
  • Clean trolley or tray with disinfectant wipes.
  • Perform hand hygiene.
  • Open sterile dressing pack. Using ANTT, assemble sterile file, open all other equipment onto sterile field.
  • Apply PPE.
  • ‘Scrub the hub’ of the port of PN bag with 2% chlorhexidine and 70% isopropyl alcohol wipe for 30 secs, break seal and allow to dry.
  • Insert administration set spike into port of PN bag and prime administration set.
  • Repeat for lipids (if applicable)
  • Attach primed administration set to needle free access device.
  • Insert administration set into infusion pump, set rate, open clamp and commence infusion.
  • Discard all disposable equipment.
  • Remove PPE and discard as healthcare waste.
  • Perform hand hygiene.
Aftercare

Document procedure and complete CVAD bundle.

Update fluid balance chart.

Ensure VAD is positioned correctly to ensure skin health is maintained.

Disconnecting parenteral nutrition/support (using a standard ANTT® approach)

Statement To ensure safe care and maintenance of catheter device and maintain patency of catheter/device when disconnecting Parenteral Nutrition/Support.
Requirements
  • PPE (minimal considerations disposable apron)
  • Clean tray or trolley
  • Sterile sheet x 2 or dressing pack
  • 10ml luer lock syringes
  • 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
  • 21g safety hypodermic needle or 18G blunt filter needle
  • Curos cap (disinfection cap) (x1 per lumen)
  • IV 0.9% Sodium Chloride (NaCl) (appropriate volume for patient and VAD)
  • Catheter lock (if required)
  • Clinical waste bag
  • Sharps bin.
Timing As required.
Procedure
  • Explain the process to the child and parent and gain consent.
  • Perform hand hygiene.
  • Apply apron.
  • Clean trolley or tray with disinfectant wipes.
  • Perform hand hygiene.
  • Open sterile dressing pack. Using ANTT, assemble sterile file, open all other equipment onto sterile field.
  • Apply gloves.
  • Clamp administration set, stop pump and disconnect administration set.
  • Using ANTT, attach the prefilled syringe to the needle free access device. Administer flush using a push/pause technique and clamp under positive pressure.
  • Administer catheter lock (if applicable)
  • Attach curos cap to each lumen.
  • Discard all disposable equipment.
  • Remove PPE and dispose of healthcare waste.
  • Perform hand hygiene.
Aftercare

Document procedure and complete CVAD bundle.

Update fluid balance chart.