How To Use a Curlin Pump for TPN

TPN, or total parenteral nutrition, is the solution administered to a patient who has underlying absorption disorders or is unable to take nutrition by mouth.

Usually, TPN solutions are given intravenously. In most cases, patients have to take these solutions regularly.

A Curlin pump can be used to infuse precise fluids daily. 

In this article, we will take a closer look at the Curlin pump and how to use it to administer TPN solutions in continuous mode.  

What Is A Curlin Pump, and Who Needs It?

Curlin pumps are devices that are specifically designed for use with intravenous (IV) therapy. 

When combined with total parenteral nutrition solutions, Curlin pumps help deliver the nutrients and fluids directly into the bloodstream. 

This tool is vital because TPN solutions are often very concentrated and challenging to absorb when taken orally. It is also helpful as it guides the patient through his/her daily medicine/nutrition intake.

How To Use a Curlin Pump

This guide will describe the use, loading, and priming of the Curlin pump. There will also be some valuable tips to ensure you carry out the infusion process without any errors.

Before the Start of Therapy:

• If you have placed your TPN bag in the refrigerator, remove it and keep it at room temperature for 2 – 3 hours (or as specified on the bag’s label).
• Inspect the bag for any leakage or contamination. 
• Look at the label and verify your information. Make sure that your name and medications are written correctly. Don’t forget to check the expiration date and amount of TPN.
• Select a suitably clean area or clean an area with an approved cleanser to prepare your TPN. Wash your hands with antibacterial soap and water or hand sanitizer.
• Now collect your TPN bag, IV tubing, flush syringes, and alcohol swabs in one place.
• Prepare your flush syringes. Remove the extra air from the syringe by pressing the plunger. Remove as much solution as instructed by your nurse. Repeat the step with all of your syringes. 

Pro Tip: Keeping the bag at room temperature is recommended, as cold TPN infusions may cause chills and headaches. Never speed up the heating process by warming the bag or placing it in the oven. 

Starting the Therapy

Preparing IV Tubing:

• First, take the tubing out of its package. Don’t forget to remove the breakaway tab from the yellow flow stop. 
• Now remove the cover from both the IV tubing spike and the TPN bag. Don’t touch the end of the tubing spike with your hands. 
• Next, insert the spike into the bag port. Be careful not to puncture the bag with the spike. The spike should be inserted far enough to reach the medications. 

Loading the Tubing With the Pump:

• First, you will need to put the IV tubing into the pump. 
• Find the door on top of the pump. Pull the latch up and all the way open. 
• Remove the previous tubing, if any, and discard them properly as guided by your nurse.
• Now, place the tubing so that the blue tubing guide pin is in the opening near the blue arrow. Press with a finger gently to insert it firmly. 
• Next, stretch the tubing on top of the meter, aligning it in the tubing track.
• Repeat this process with a yellow flow stop on the opposite side and insert it in the opening near the yellow arrow.
• Ensure that the tubing is in the notch area under the door hinge. This will prevent the rupturing of tubes.
• Close the door, and your pump is ready to use.

Turning on the Pump and Priming the IV Tubing:

• The purpose of priming is to remove any excess air from the tube so it may not enter the patient’s body. 
• For this, turn on the pump by pressing the orange ON/OFF key. You may hear a series of beeps as the device does a quick automatic internal check. 
• Now, you will be directed toward the “Program/Library” screen. Select the “Program” with UP/DOWN arrows and YES keys. 
• Next, there will be two options: “Repeat Rx” or “New Program.” Select Repeat Rx with the YES key. The Repeat RX option has a prerecorded medication administration manual set by your pharmacy or nurse. 
• Now, your Curlin pump monitor will give you four choices. Before starting the administration process, you have to prime your IV tubing. 
• To do so, press and hold the PRIME key at the bottom right corner of the pump. Keep pressing the key until a small amount of solution oozes out from the tubing. 
• When you release the PRIME key, the screen will ask you to press YES to exit. Press the YES/ENTER key to return to the previous menu.

Pro Tip: While priming, ensure the tubing is not connected to the patient.  

Now, you are ready to infuse the TPN. 

Flushing the Catheter Before Infusion:

• First, you have to flush your catheter.
• To flush the catheter with saline, first remove any alcohol containing caps from the catheter hub. Cleanse the hub of the catheter with alcohol pads for at least 20 seconds – ensuring this does not touch anything until saline syringe is connected. Remove the cap from the flush syringe.
• Connect the saline syringe to the hub of the catheter, release the clamp on the IV catheter, and flush it using the push/pause method. Lastly, discard the syringe.

Pro Tip: Don’t push the fluid at once while flushing the IV catheter. Also, stop the process if there is resistance, and consult your doctor/nurse.

Administering the Medications: 

• Connect the IV tubing/Curlin tubing with the catheter. Make sure it is connected firmly, and all the clamps are released.
• Select RUN with the help of the ARROW and YES keys. 
• The display will show your medication program, including medication type, interval, and dosing. Compare it with the label on the medication bag. You can stop the process using the RUN/PAUSE key if you find a discrepancy between the medications on display and on the label.
• After the process has started, a green light below the monitor will show that your infusion is being administered. You can also see the administration rate and time on the pump monitor.

Pausing/Resuming the Pump:

• If you have an emergency or want to pause your infusion for a while, press the green RUN/PAUSE key. 
• A yellow standby indicator will be turned on, and three options will appear on display; “Resume,” “Repeat Rx,” and “New Program.” 
• By default, “Resume” is selected. You can reinitiate the process by pressing the YES key. 

Most Curlin pumps have an innate feature that will alert you after one or two minutes of being on pause to ensure that you haven’t forgotten about the infusion. You can silence the alarm by pressing the DOT key at the bottom of the interface.

Ending the Infusion:

If you want to change the medication bag or end the infusing process, press the RUN/PAUSE key. 

Remove the IV tubing from the catheter and turn off the pump by pressing the orange ON/OFF key. 

Get a prefilled saline syringe and heparin syringe for flushing the central line after TPN infusion if you are doing cyclic feeding. First, flush the central line with saline and then with heparin (if ordered) by repeating the following steps:

1. Hold the saline syringe with the tip upright and gently push the plunger forward to expel air bubbles from the syringe. 
2. Now use a new alcohol pad to scrub the catheter injection cap.
3. Without touching the tip of the injection cap, insert the saline syringe into the center of the IV catheter cap.
4. Once inserted, push and twist the saline syringe clockwise to secure the connection and unclamp the IV extension of the catheter. 
5. Flush your central line with saline in a push and pause method as instructed by your nurse. In this method, you will first push the plunger and then pause for a second and push the plunger again until your central line is completely flushed.
6. Now clamp your central line and remove the syringe by holding the bottom of the injection cap (not the central line). Discard the syringe in the sharps container. 
7. For a heparin flush, repeat the same steps you’ve followed for a saline flush. 

After the Therapy:

• Discard all the IV tubing as instructed by your nurse. 
• If you have to use the catheter or tubing again, cover the tip of the tubing with a sterile cap. 

Continuous Therapy Mode:

The pump will infuse the medications at a constant rate if “Continuous mode” is selected. 

Usually, your nurse/pharmacist pre-programs the pump in Continuous mode, but you can change it in the OPTIONS menu just before starting the infusion.

You can also change the units, delay time, medicine limit, and input concentration in the OPTIONS menu.