TPN can be lifesaving for patients unable to tolerate enteral feedings. However, there are numerous risks associated with TPN; these risks should be balanced against benefits when deciding to initiate TPN. Most errors arise from fluid miscalculations or from re-writing the previous day's TPN incorrectly. TPN orders are usually triple-checked, but you must still be careful and recalculate your fluid and other components daily. At our hospital, the TPN is now out-sourced to a private company, so the TPN orders must be received by Pharmacy before 2:00 pm. The NICU has standard starter TPN bags, if needed; these are for premies born after the 2:00 pm cutoff so they don't have to go more than 24 hours without nutrition. Remember to meticulously follow all patients on TPN for complications, as well as for the continued need for TPN. Utilize the services of the Pediatric Nutrition Support Dietitian for help with any TPN problems or questions. Consult the pediatric TPN team (Julie Johannsen-Wilk, R.D., Drs. Burkhead and Witkowski and various consultants, like Pharmacy) as early as possible if considering home TPN on any patient.