HIGH-OSMOLALITY FEEDINGS DO NOT INCREASE THE INCIDENCE OF THROMBOPHLEBITIS DURING PERIPHERAL IV NUTRITION

Background: Peripheral IV nutrition has been advocated for patients wh o require short-term IV nutrition support to avoid the complications a nd expense of central venous catheterization. Feeding formulas for per ipheral administration have usually been modified by increasing the pr oportion of lipid, because increasing osmolality is reported to cause thrombophlebitis. The aim of this study was to determine whether stand ard feeding formulas can be given via the peripheral route and also to establish whether increasing osmolality does increase the incidence o f thrombophlebitis under these conditions. Methods: Thirty-six patient s requiring parenteral nutrition were randomized to receive either a ' 'high'' (1700 mOsmol/L) or ''standard'' (1200 mOsmol/L) osmolality fee ding containing 2000 kcal and 12 g nitrogen via a peripheral line. Res ults: Twenty patients (mean age 55.6 years, range 16 to 78) received s tandard osmolality feedings using 20 peripheral feeding lines for a me an duration of 6.8 days (range 2 to 16) with 10 line failures (8 throm bophlebitis, 2 occlusion). Nineteen patients (mean age 56.1 years, ran ge 27 to 83) received high osmolality feedings via 20 lines for a mean of 6.3 days (range 0 to 18) with five line failures (4 thrombophlebit is, 1 occlusion), one failed insertion, one line removed at the patien t's request, and four lines that fell out. Forty lines were inserted o verall of which 19 (47.5%) were removed electively, 12 (30%) developed thrombophlebitis, 3 (7.5%) occluded, 4 (10%) fell out, 1 (2.5%) was a failed insertion, and 1 (2.5%) was removed for nonmedical reasons. Co nclusions: Increasing osmolality of total parenteral nutrition did not increase episodes of thrombophlebitis in this trial and did not affec t the success rate of the lines. We conclude that standard total paren teral nutrition formulas of higher osmolality than previously thought can be safely given via the peripheral route for short-term feeding an d do not increase the risk of thrombophlebitis.