These instructions are for Children’s Hospital of Philadelphia (CHOP) patients that need to add medicines to the bag of home intravenous (IV) nutrition, also known as parenteral nutrition (PN).

Important information before you go home:

• Adding medicines to home PN should be done right before you use the bag of PN because some medicines are affected by light.  
• For dual chamber bags, do not remove the bar on the bag until all medicines have been injected.
• An infusion nurse will meet you at home to review how to add your child’s medicines to the PN bag.

Instructions for preparing pediatric or adult multivitamin mixture:

Adult and pediatric vitamins come in 2 vials. The contents of both vials are combined into one syringe before injecting into the PN bag.  

1. Clean hands with soap and water. Prepare your space and prep surface area as you were taught.  
2. Gather your supplies:
   • Hand sanitizer  
   • Timer to track clean times  
   • Alcohol pads  
   • Syringes   
   • Needles   
   • Multivitamin vials (vial 1 and vial 2)  
   • Sharps container  
3. Check expiration dates for all supplies. Use oldest supplies first. Check vial labels to ensure you have the correct multivitamin ordered for your child.  
4. Clean hands using hand sanitizer. Use soap and water if hands are visibly dirty.  
5. Open the packages of syringes and needles and put them together. Sometimes the syringes are packaged with needles already attached.  
6. Remove the plastic cap from the top of each vial. Scrub the rubber portion of each vial top with an alcohol pad for 15 seconds. Allow to dry for 15 seconds. Use a new pad for each vial.  Do not blow or fan over the vial to dry. If anything touches the top besides your needle, you must clean again.    
7. Remove the needle cap and pull air into the syringe as you were taught.  
8. Inject air into vial 1 as you were taught and then withdraw the liquid from the vial. Refill the syringe with air and inject air into vial 2 as you were taught and withdraw the liquid from vial 2.    
9. Remove the needle from the vial. Replace the needle cap.  
10. Get new supplies if your needle touches anything other than your cleaned bottle top while preparing the vitamins.    
11. You are now ready to add the vitamins to the PN bag. Steps are listed below.

Instructions for preparing prefilled medicine syringes:

The needle may already be attached for some prefilled medicines. Proceed to the next section if the needle is attached to the medicine.

1. Clean hands with soap and water. Prepare your space and prep surface area as you were taught.
2. Gather your supplies:
   • Hand sanitizer
   • Timer to track clean times
   • Alcohol pads
   • Syringes  
   • Needles  
   • Sharps container
3. Check expiration dates for all supplies used. If not expired, use oldest supplies first. Check syringe label to ensure you have the correct medicine.
4. Clean hands using hand sanitizer. Use soap and water if hands are visibly dirty.
5. Open the needle package at the end away from needle tip.   
6. Remove cap covering the end of the medicine syringe.
7. Twist the end of the syringe to the right to screw into the end of the needle.  
8. You are now ready to add the medicine to the PN.

Instructions for injecting medicines into the PN bag:

All medicines should now be in syringes with needles attached.   

1. Clean hands. Prepare your space and prep surface area as you were taught.
2. Remove the foil from the injection port on the PN bag (if necessary).   
3. Scrub the injection port with an alcohol pad for 15 seconds.  Allow to dry for 15 seconds. Do not blow or fan over the injection port to dry. If anything touches the port other than the needle, you must clean again.   
4. Remove the needle cap from the medicine syringe and push the needle into the injection port. Never lay the needle down without a cap. If the end of the needle touches anything, you must get new medicine and supplies.
5. Inject all of the medicine in the syringe into the bag. It is helpful to keep the PN bag on a table with the injection port straight.  Be careful not to push the needle through the PN bag!
6. Pull the needle out of the injection port and place into sharps container.
7. Repeat steps 3-6 for any other medicines you need to add.  
8. Always scrub the injection port clean with a new alcohol pad before injecting each medicine.
9. Put all the syringes and needles in a safe disposal container.
10. Turn the PN bag upside down several times to mix the medicines with the PN.
11. Look closely at your PN bag. Do not use the bag if you see any particles or if the mixture looks cloudy.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.

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