Emergency Guide — YourTubie Passport

Call 999 immediately if:

Severe breathing difficulty · Chest pain · Collapse or loss of consciousness · Signs of severe sepsis (see below)

Parenteral Nutrition (TPN) — Line Emergencies

Signs of CRBSI (Line Infection)

CRBSI (Catheter-Related Bloodstream Infection) is a serious complication of TPN lines.

Temperature >38°C or <36°C
Shivering, rigors (uncontrollable shaking) — especially during infusion
Redness, swelling or discharge at the line entry site
Feeling suddenly unwell during or after infusion
Rapid heart rate or low blood pressure

STOP the infusion immediately. Call your nutrition nurse or go to A&E. Do not restart until assessed.

Blocked or Damaged Line

If pump shows occlusion alarm — stop infusion, do not force flush
Never use excessive force to flush a blocked line
Contact your nutrition nurse or IV pharmacy for guidance
If the line appears cracked or damaged — clamp it and call immediately

Accidental Line Disconnection

Clamp the line immediately to prevent air entry
Lie flat if possible — reduces risk of air embolism
Do not reconnect yourself unless trained to do so
Call your nutrition nurse immediately or go to A&E

Air in the Line

Small bubbles in tubing are usually harmless
Large air bubble or pump air alarm — stop infusion
Lie on your left side, head down if possible
Call 999 if you feel chest pain, breathlessness, or collapse

Enteral Nutrition — Tube Emergencies

NG Tube Has Come Out

Stop the feed immediately
Do NOT reinsert an NG tube yourself
Do NOT restart the feed until tube position is confirmed by pH testing or X-ray
Contact your nutrition nurse or go to hospital for reinsertion

Feeding into a misplaced NG tube can be life-threatening.

PEG / Gastrostomy Tube Issues

Tube has fallen out: Cover the stoma site with a clean dressing. Go to hospital within 4–6 hours — the stoma can close quickly
Leaking around tube: Contact nutrition nurse — do not increase balloon water
Buried bumper: Tube feels stuck or pain when rotating — contact your team, do not force it
Skin infection around site: Redness, discharge, odour — contact team for antibiotic assessment

Vomiting During Feed

Stop the feed
Sit upright — never lie flat after vomiting during tube feeding
Check tube position before restarting
If vomiting repeatedly or vomiting feed — contact your nutrition team
Signs of aspiration: coughing, breathlessness, chest pain → call 999

Pump Alarm Guide

Occlusion: Kink in tube or tube kinked at site — check the line, do not force
Air in line: Re-prime giving set
End of feed: Normal — remove bag, flush tube per your care plan
Low battery: Connect to mains power
Dose complete: Feed finished — flush per plan

Other Urgent Situations

Signs of Dehydration

Dark urine, dry mouth, headache
Dizziness when standing, rapid heartbeat
High urine output through stoma without replacement

Contact your nutrition team if you are not meeting your fluid prescription. Go to A&E if severely unwell.

Low Blood Sugar (if applicable)

Shaking, sweating, confusion, feeling faint
TPN patients: do not stop infusion suddenly — taper if needed
Contact your team if blood glucose is consistently low or high

When to call who

Situation	Who to call
Collapse, severe chest pain, difficulty breathing	999
Signs of CRBSI / rigors during TPN infusion	999 or A&E immediately
NG tube has come out	Nutrition nurse or hospital
PEG / gastrostomy tube has fallen out	A&E within 4–6 hours
Pump alarming repeatedly / cannot resolve	Nutrition nurse / IV pharmacy
Blocked line (cannot flush)	IV pharmacy / nutrition nurse
Feeling generally unwell, unsure	111
Routine questions about your feed or equipment	Dietitian or nutrition nurse

This guide is based on NHS and BAPEN clinical guidance for home nutrition support patients. Always follow the specific instructions provided by your own clinical team, as individual care plans may differ.

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