Parenteral Nutrition (PN)

What is parenteral nutrition?

Parenteral nutrition (PN) is a liquid given to a person who cannot eat or tolerate enough food or formula to stay well nourished.

PN is given through a vein and is made-up of carbohydrate, protein, fat, vitamins, and minerals. In most cases, your child can get the same level of good nutrition from PN as they would from eating a well-balanced diet. 

What is in PN?

PN contains the following:  

  • Amino Acids: the “building blocks” of proteins important for building muscle
  • Dextrose/Glucose: a carbohydrate/sugar source used as fuel or energy for the body
  • Lipids: a source of fat and calories important for growth and development
  • Vitamins and minerals

What is the difference between eating and getting PN?

When you eat, food is digested and broken down by the intestine. Some of this food is absorbed into the bloodstream. It is used by the body for energy, weight gain, and growth. Undigested food is eliminated from the body as waste.

PN goes directly into your child’s bloodstream where it is absorbed by the body. When getting PN, almost none of the nutritional elements are lost as waste.

Why does my child need PN?

Children need enough nutrients each day to support normal growth, weight gain, and development of the brain. PN may be used when a child cannot eat or drink enough calories by mouth and cannot tolerate tube feeding or absorb enough nutrients in the intestines to achieve an age-appropriate rate of weight gain/growth.

How long will my child need to receive PN?

This depends on a few things and is different for every child. Talk with your child’s healthcare provider to discuss the best plan for your child.  

  • PN is usually weaned or decreased slowly
  • PN is usually not stopped abruptly for safety reasons
  • The plan to stop PN will be decided based on food and fluid intake, and weight

How will PN affect my child’s appetite?

Every child responds differently to receiving PN.

Children who receive all of their calories from PN should feel satisfied and not hungry or uncomfortable. Children who receive only part of their nutrients through PN may feel hungry.

Children can and should continue to eat while on PN if deemed safe by their doctor. It may take a little while for your child's appetite to fully return after the PN is stopped. Other factors affecting appetite include:

  • Medicines
  • Surgery or other medical procedures  
  • Some medical conditions
  • Stress

How will my child be monitored while receiving PN in the Hospital?

All children who start PN while admitted to the hospital are seen by the Nutrition Support Service (NSS). The NSS consists of: Nutrition Support Physician and Registered Dietitian (RD).

After PN is started, the RD will perform a nutrition assessment on your child to determine nutritional needs. The RD will make suggestions about your child’s PN based on their needs. The RD will monitor your child’s nutritional status by checking lab values, changes in medical condition and weight. The NSS team will work with your child’s doctors to adjust the PN as needed.  

The NSS team will meet weekly to review your child’s nutrition while on PN. The RD will help the medical team transition your child from PN to an oral diet or tube feeding as needed.

Will my child go home on PN?

Most of the time PN is stopped once your child can take adequate nourishment by mouth or through tube feedings. Nourishment is essential for normal growth, weight gain, and development. Your child may need to go home on PN if they cannot meet nutritional needs by any other way.

If your child is going home on PN, we strongly recommend that two caregivers attend the following classes in the Family Learning Center (FLC) at CHOP:

  • Class to review central line care if you have not already received this
  • Class to teach you how to set it up and give PN at home

After you complete your FLC classes, you must practice these skills with your bedside nurse using your child’s central line and meet further with members of the Home PN or Intestinal Rehabilitation Program (IRP) team.

A home infusion company will supply you with the PN and will send an infusion nurse to your home to teach you how to give the PN. You may call the infusion company with questions any time of the day or night.

The home infusion pharmacist or one of the members of the Home PN or IRP team will call you if there are any changes to the PN prescription.

Will we need to come to CHOP for follow-up appointments?

A follow-up appointment will be set before your child is discharged from the hospital. All appointments occur on the 6th floor of the Buerger Building. Most children will have appointments every 1-4 weeks.

Your child may need to have blood work done during their appointment. Sometimes blood work may be ordered and drawn by the home infusion nurse during a home visit. 

Arrangements should be made to have your child’s blood work done before your team’s PN review day. The Home PN team meets every Tuesday to review the PN orders, and the Intestinal Rehabilitation Program (IRP) team meets every Wednesday to review PN orders.

Members of the Home PN and IRP team will work with your other medical providers to adjust your child’s plan of care based on the results of their bloodwork. 

What do I need to know about the supplies for PN?

There have been many nationwide shortages of the additives for your child’s PN solution. Because of these shortages, we may need to make changes in your child’s PN solution, check blood work more often, or change home infusion companies to provide the best care for your child. You may receive some supplies that are different than those received from CHOP.  

If you notice a different product or a change that was not already reviewed with you by your team, call your home PN provider to discuss these differences.

Who can I call if I have questions or concerns about my child’s PN solution or central line?

Mondays through Fridays, from 8 a.m. – 4:30 p.m., call the CHOP team managing your home PN:

  • Home PN patients: 215-590-8743
  • IRP patients: 215-590-1680

During off hours or holidays, call 215-590-1000 and ask the operator to page the GI Fellow on call. If your child is not a GI patient but sees a doctor in another service, such as Oncology, please contact that service.

Your home infusion company is available for questions and concerns at any time.

Important reasons to call your healthcare team or home PN provider at CHOP:

  • Temperature of 100.4 F or higher
  • Oncology patients: Fever of 101.3F or higher, OR 3 low grade temperatures between 100.4-101.2 in 24 hours (at least 2 hours apart)
  • Vomiting or diarrhea
  • G-tube drainage or increased ostomy drainage
  • Any urgent concerns

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