Home Total Parenteral Nutrition (TPN): Your Complete Guide

Total parenteral nutrition — TPN, also called parenteral nutrition (PN) or home parenteral nutrition (HPN) — is a way of providing complete nutrition directly through a vein when the digestive system cannot be used. If you are going home on TPN, this guide will help you understand how to manage it safely and effectively.

Home TPN is a significant undertaking, and your care team will provide thorough training before discharge. This guide reinforces and supplements that training. Always follow your specific instructions when they differ from anything here.

Why You Need TPN

TPN is prescribed when the gastrointestinal (digestive) tract is not functioning adequately to absorb nutrients. Common reasons include:

Short bowel syndrome (significant portions of the intestine have been removed)
Severe Crohn’s disease or other inflammatory bowel disease
Bowel obstruction or ileus (intestinal paralysis)
Severe malabsorption
Post-surgical recovery where the bowel needs complete rest
Severe nausea or vomiting preventing any oral intake for a prolonged period
Certain cancers affecting the bowel

TPN provides everything your body needs to function: calories, protein, fats, fluids, electrolytes, vitamins, and minerals — all delivered directly into the bloodstream through your central catheter.

What Is in Your TPN Bag?

Your TPN formula is custom-compounded by a specialized pharmacy based on your specific nutritional needs, lab values, and medical condition. It typically contains:

Dextrose (glucose): Your primary carbohydrate source. Provides calories for energy. Dextrose in IV form is highly concentrated — too concentrated for peripheral veins, which is why TPN must go through a central line.

Amino acids: The building blocks of protein, used for tissue repair, immune function, and countless other body processes.

Lipid emulsion: Fat, provided as an emulsion (milky white solution). Provides calories, essential fatty acids, and fat-soluble vitamins. May be added directly to your TPN bag (as a three-in-one or “total nutrient admixture”) or infused separately.

Electrolytes: Sodium, potassium, chloride, calcium, magnesium, phosphorus — adjusted based on your blood tests to maintain the right balance.

Vitamins: A complete multivitamin mixture, typically added daily.

Trace elements: Zinc, copper, manganese, selenium, chromium, and others.

Your TPN formula changes. As your labs fluctuate, your nutrition support team adjusts the composition of your bags. Never assume your formula is the same from bag to bag — always check the label.

Your Equipment

The TPN bag

TPN is delivered in a clear or slightly opaque IV bag, typically 1–3 liters, that arrives refrigerated from your home infusion pharmacy. Bags are usually delivered weekly or bi-weekly.

The infusion pump

TPN is delivered via a programmable infusion pump. Your home infusion nurse will train you on your specific pump model. The pump controls the exact rate at which TPN flows, allows for a ramp-up (gradual increase) and ramp-down (gradual decrease) at the start and end of infusion, and alarms if problems occur.

IV tubing and filters

TPN requires a special IV tubing set with an in-line filter — typically a 1.2-micron filter to remove any particles and a 0.22-micron filter if the lipid emulsion is separate. Using the correct filter is important for safety; your pharmacy supplies the correct tubing.

Central catheter

TPN must go through a central line — a PICC, tunneled catheter, or implanted port. Peripheral IVs and midlines cannot safely deliver TPN due to the high concentration of the solution, which would damage small veins.

Storage and Preparation

Storing your TPN bags

Store all TPN bags in the refrigerator (2–8°C / 36–46°F) until use
Never freeze TPN bags — freezing destroys the emulsion and can be dangerous
Keep TPN bags in their original packaging until use
Check the expiration date and beyond-use date on every bag before use

Preparing for infusion

Remove the bag from the refrigerator 30–60 minutes before infusion time — starting cold TPN can be uncomfortable and may irritate the vein
Hold the bag up to the light: the solution should be clear, yellow-tinged (or white if lipid is included). Never use a bag that:
- Looks cloudy (unless it is the lipid-containing type, which is normally white/milky)
- Has visible particles or floating material
- Has a broken seal
- Is expired
- Shows any sign of damage
If anything looks wrong, call your pharmacy — do not use the bag

Vitamin and additive additions

Your pharmacy prepares your TPN with all required additives. You should generally not be adding anything to your TPN bag at home unless specifically instructed and trained to do so. Some pharmacies may instruct you to add a vitamin vial just before infusion — follow those instructions exactly.

The Infusion Cycle

Most home TPN patients use cyclic TPN — infusing over 10–16 hours overnight (often 12 hours), rather than 24 hours continuously. Cyclic infusion allows the body a daily “rest” period from the TPN, which is better for liver health, allows greater mobility during the day, and helps preserve any remaining ability to eat.

A typical overnight TPN cycle

Evening (start):

Wash hands thoroughly.
Remove TPN bag from refrigerator (30–60 min before starting if possible).
Inspect the bag (clarity, expiration, intact seal).
Prepare the new IV tubing set with filter. Prime the tubing with TPN solution per pump instructions.
Scrub the catheter hub (15 seconds alcohol wipe, 15 seconds dry).
Flush the catheter with saline (10 mL).
Attach the TPN tubing to the catheter.
Set the pump to the prescribed rate and cycle.
Confirm the pump is running and the first rate is as expected (ramp-up).

During the infusion (while you sleep):

The pump manages the rate automatically, including the ramp-up and ramp-down.
Do not kink or compress the tubing.

Morning (completion):

Confirm the bag is empty and the pump has completed.
Flush the catheter with saline (10 mL).
Lock with heparin if prescribed.
Disconnect and discard used tubing (new tubing is used each day).
Record completion in your log.

Daily Monitoring

Monitoring yourself closely is critical on home TPN. Your care team will give you a specific log to complete each day.

Daily checks you perform

Weight: Weigh yourself at the same time each day (after your TPN has finished and after your first morning urination), on the same scale, wearing the same amount of clothing. Record the result. A weight gain of more than 1–2 pounds (0.5–1 kg) overnight, or more than 5 pounds (2.3 kg) in a week, may indicate fluid retention — report it to your care team.

Temperature: Check your temperature before starting TPN each evening. Do not start TPN if you have a fever (≥38°C / 100.4°F) — call your care team first. Fever with a central line is a potential sign of infection.

Blood glucose: Your care team may instruct you to check blood glucose (finger-stick blood sugar) during TPN infusion and/or after it ends — particularly when first starting TPN and after formula changes. High blood glucose (hyperglycemia) can result from the dextrose in TPN, especially in patients with diabetes or those who are acutely ill. Low blood glucose (hypoglycemia) can occur when TPN is stopped abruptly.

Urine output: Note approximately how much urine you are producing. A significant decrease can signal dehydration or kidney issues.

How you feel: Record any symptoms: nausea, headache, unusual fatigue, shortness of breath, swelling, abdominal discomfort, or anything that feels different from your baseline.

Lab Monitoring

TPN requires frequent blood tests to ensure your formula is optimized and to catch metabolic complications early. Lab frequency is highest when starting TPN and during any significant illness; it decreases once you are stable.

Typical monitoring labs include:

Basic metabolic panel (BMP): Electrolytes, kidney function — frequently
Liver function tests (LFTs): TPN can affect the liver with long-term use
Triglycerides: If your TPN contains lipids
Prealbumin/albumin: Markers of nutritional status
Complete blood count (CBC)
Trace element levels: Zinc, copper, selenium, and others (periodically)
Iron studies, B12, folate (periodically)

Your nutrition support team adjusts your TPN formula based on these results. Never skip scheduled lab draws.

TPN Complications: What to Know

Infection (most serious)

A central line-associated bloodstream infection (CLABSI) is the most serious and most common serious complication of home TPN.

Signs: Fever (≥38°C / 100.4°F) with shaking chills, particularly if it develops during or shortly after a TPN infusion.

What to do: Do not start TPN. Call your care team or go to the emergency room immediately. Blood cultures must be drawn to identify any infection. Catheter removal may be required.

Prevention: Meticulous hand hygiene and catheter care technique every single time. Never rush or cut corners.

Hyperglycemia (high blood sugar)

The dextrose in TPN can raise blood glucose, particularly at the start of therapy or with formula changes.

Signs: Increased thirst, frequent urination, blurred vision, fatigue, headache.

What to do: Monitor blood glucose as instructed. Report elevated readings to your care team. Insulin adjustments may be needed.

Hypoglycemia (low blood sugar)

Can occur if TPN is stopped suddenly without a proper ramp-down.

Signs: Shakiness, sweating, dizziness, confusion, heart pounding.

What to do: Do not abruptly stop TPN. Always follow the ramp-down process. If your pump alarms and stops infusion unexpectedly, have juice or glucose tablets available as a short-term measure; call your care team.

Electrolyte imbalances

Sodium, potassium, magnesium, phosphorus, and other electrolytes can become abnormal on TPN.

Signs: Vary by electrolyte — muscle cramps, weakness, irregular heartbeat, confusion, or feeling “off.”

What to do: Maintain your lab schedule. Report new symptoms promptly.

TPN-associated liver disease

Long-term TPN can affect liver function, causing a range of problems from mild enzyme elevation to cholestasis (bile flow obstruction). Regular liver function monitoring, cycling TPN (using overnight cycles rather than 24-hour continuous infusion), allowing oral or enteral nutrition when possible, and occasionally adjusting the formula all help manage this risk.

Refeeding syndrome

When severely malnourished patients restart nutrition (including TPN), a dangerous shift in electrolytes — particularly phosphorus, potassium, and magnesium — can occur as cells begin using nutrients again. Your team manages this risk closely when TPN is initiated, which is why labs are checked very frequently in the first week.

Catheter occlusion (blocked line)

TPN residue can contribute to catheter clotting over time. Consistent saline flushing before and after each infusion is essential.

Can I Also Eat?

If your digestive system is capable of absorbing any nutrition, your care team will strongly encourage you to eat and/or use tube feeding whenever possible — even small amounts of oral or enteral intake (through a feeding tube) are beneficial for gut health and may reduce TPN-related complications.

Your nutrition support team will regularly assess whether your TPN can be reduced or weaned as your oral intake increases. The goal for most patients is to transition off TPN entirely when the gut recovers sufficient function.

Ask your team: “Is there any amount of eating or drinking I can do alongside TPN?”

Living on Home TPN

Managing home TPN while maintaining quality of life is absolutely achievable, though it requires planning and adjustment.

Overnight cycling preserves your daytime freedom — most patients can work, socialize, and pursue activities during the day
Travel is possible with careful planning around medication refrigeration, supply delivery, and scheduling (see our Travel guide)
Support networks — patient organizations like the Oley Foundation (oley.org) connect home TPN patients with each other and provide resources, community, and practical advice
Mental health matters — adjusting to life on TPN is emotionally challenging. See our guide: Mental Health and Emotional Adjustment During IV Therapy

When to Call Your Care Team vs. Go to the ER

Call your TPN pharmacist or nutrition support team for:

Questions about your formula or schedule
Pump malfunction or alarms you cannot resolve
Bag that looks abnormal or is damaged
Running low on supplies

Call your home infusion nurse for:

Catheter site concerns
Questions about flushing, connections
Lab scheduling

Go to the Emergency Room immediately for:

Fever (≥38°C / 100.4°F) with shaking chills — possible bloodstream infection
Chest pain or shortness of breath
Signs of severe hypoglycemia that do not respond to oral glucose
Signs of severe allergic reaction
Catheter complications (falls out, significant bleeding, air embolism symptoms)

This guide is for educational purposes. Home TPN management is individualized — always follow the specific instructions of your nutrition support team, home infusion nurse, and pharmacist.