title: A randomised study of the effects of osmolality and heparin with hydrocortisone on thrombophlebitis in peripheral intravenous nutrition.
abstract: Intravenous nutrition administered via the central route incurs both the risks of catheter insertion and catheter related sepsis. Peripheral intravenous nutrition avoids these risks but is associated with a high risk of thrombophlebitis. We undertook a study to look at the incidence of thrombophlebitis caused by the infusion of a) a 'ready to use' mixture (Vitrimix KV) with an osmolality of 1130 mOsmol/kg, b) Vitrimix KV plus heparin and hydrocortisone, and c) a feed, with an osmolality of 700 mOsmol/kg, with heparin and hydrocortisone, to investigate the effects of the addition of heparin and hydrocortisone and the effect of osmolality on the incidence of thrombophlebitis. The addition of heparin (500 u/l) and hydrocortisone (5 mg/l) to Feed A significantly reduced the daily risk of thrombophlebitis from 0.43 to 0.11 episodes per patient, p < 0.01. A reduction in the osmolality resulted in a further fall in the incidence of thrombophlebitis to 0.04 episodes per patient with a significant increase in the median life span of the cannula from 26 h to 86 h, p < 0.02. Our data show that a low incidence of thrombophlebitis can be achieved by the use of a low osmolality feed with heparin and hydrocortisone. It is recommended that peripheral intravenous nutrition be used in patients who require nutritional support for less than 10 days.
authors.affiliation: University Department of Surgery, The General Infirmary, Leeds LS1 3EX, UK.
authors.forename: M
authors.initials: M
authors.lastname: Madan
authors.forename: D J
authors.initials: DJ
authors.lastname: Alexander
authors.forename: E
authors.initials: E
authors.lastname: Mellor
authors.forename: J
authors.initials: J
authors.lastname: Cooke
authors.forename: M J
authors.initials: MJ
authors.lastname: McMahon