title: Safety and efficacy of total parenteral nutrition delivered via a peripherally inserted central venous catheter.
abstract: Central venous catheters for total parenteral nutrition (TPN) have traditionally been inserted via direct cannulation of the subclavian vein, but this technique requires physician participation and is associated with well-described complications. We report the single largest institutional experience with peripherally inserted central venous catheters (PICC lines) used exclusively for TPN in non-intensive care unit patients. From July 1991 to March 1994, 135 PICC lines were placed in 126 patients via the antecubital vein, advanced into the central venous system, and used only for TPN. Complication rates were determined and compared with those for TPN administered through a subclavian vein-inserted central catheter. Patient demographics were similar in each group with respect to age, type of disease process, acuity of illness, and indications for nutrition support. A cumulative number of 1381 TPN days (mean = 11 days per patient) comprised the PICC line experience. Comparison was made with 135 successive standard (subclavian) central lines inserted in 105 patients for TPN administration (1056 TPN days, mean = 10 days per patient). There was no difference in the overall rate of complications between the two groups. There were no major complications that prolonged hospitalization (eg, catheter-related sepsis or pneumothorax) in the PICC group compared with three such complications in the standard group. PICC lines can be used safely and effectively for TPN and are associated with an acceptable rate of complications.
authors.affiliation: Nutrition Support Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
authors.forename: A
authors.initials: A
authors.lastname: Alhimyary
authors.forename: C
authors.initials: C
authors.lastname: Fernandez
authors.forename: M
authors.initials: M
authors.lastname: Picard
authors.forename: K
authors.initials: K
authors.lastname: Tierno
authors.forename: N
authors.initials: N
authors.lastname: Pignatone
authors.forename: H S
authors.initials: HS
authors.lastname: Chan
authors.forename: R
authors.initials: R
authors.lastname: Malt
authors.forename: W
authors.initials: W
authors.lastname: Souba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000295:instrumentation*; D012189:Retrospective Studies