9th Day In Hospital: Abdominal Paracentesis Procedure And Home Parenteral Nutrition (HPN) Training (November 15, 2024)

Ali’s sister and I spent this morning in Home Parenteral Nutrition (HPN) training, a crash course on managing Ali’s Total Parenteral Nutrition (TPN) at home. The session covered everything: how to store and prepare the Total Parenteral Nutrition (TPN) bags, connect and disconnect the infusion line, monitor for issues, and safely dispose of materials. While some of the process felt familiar, like parts of the take-home chemotherapy routine we do every two weeks, there’s much more responsibility involved with this.

For the 46 hour take home chemotherapy treatment that we do biweekly, a nurse hooks Ali up before we leave the hospital, and our job is simply to disconnect the line at home when the infusion is done. With Home Parenteral Nutrition (HPN), we’re responsible for every single step, from start to finish.

The process begins with handwashing between nearly every step to maintain a sterile environment. Weekly, we’ll need to clean the refrigerator with soap and water, disinfect it with 70% rubbing alcohol, and then store the Total Parenteral Nutrition (TPN) bags properly.

Before starting the infusion, we’ll sanitize the administration area with alcohol, mix and add vitamins to the Total Parenteral Nutrition (TPN) bag, and prime the tubing to eliminate air. Once that’s done, we’ll connect the tubing to Ali’s PICC line, flushing it with saline and heparin to keep everything functioning properly. Overnight, we’ll monitor for potential issues, like air in the line or signs of infection such as fever over 100.4°F. Finally, the infusion is disconnected every morning, completing the cycle.

Later in the day, Ali underwent another abdominal paracentesis at 2:30 PM, performed by Dr. Zain Virk. Using ultrasound guidance, Dr. Zane Virk removed 4.6 liters of fluid, breaking the record for the most fluid ever drained in one of Ali’s procedures. Not a record we wanted to break, that's for sure.

Interestingly, we noticed a stark change in the fluid’s color. It had always been a light tan or straw-yellow color, but this time it was a much darker, tea-like amber. Concerned, I sent an email to Dr. Michael Gibson to ask if this change could indicate a problem. I’m hoping to hear back tomorrow.

One confusing moment from earlier in the week: I mistakenly assumed that the GI and surgery teams were working as one unit to determine Ali’s surgical options. It turns out they are separate, so we’re waiting for updates from both specialties. Today, however, we didn’t hear back from either team.