PROSPECTIVE-STUDY OF THE ETIOLOGY OF INFUSION PHLEBITIS AND LINE FAILURE DURING PERIPHERAL PARENTERAL-NUTRITION

Four techniques of administering peripheral parenteral nutrition (PPN) were examined prospectively to investigate the role of mechanical tra uma in the development of infusion phlebitis. Patients in group 1 (n = 15) were fed via a standard 18-G Teflon cannula which was removed on completion of the infusion and was rotated to the contralateral arm ev ery day. Group 2 patients (n = 15) had a similar catheter sited in eac h forearm simultaneously, with rotation of the side of infusion each d ay. Patients in group 3 (n = 17) had a 15-cm Silastic rubber catheter inserted into a forearm vein and a standard cannula sited in the contr alateral forearm, with alternation of infusion each day. Those in grou p 4 (n = 13) had a fine-bore 23-G silicone catheter sited in one arm o nly. Patients in groups 1, 2 and 3 were fed over 12-h cycles and those in group 4 for a 24-h continuous cycle. A total of 408 patient-days o f PPN were given, Mean duration of PPN in groups 1-4 was 7.5, 9, 5.5 a nd 5 days respectively. Infusion phlebitis was not recorded in patient s who had a daily change of cannula (group 1), but occurred in four pa tients in group 2, eight in group 3 and eight in group 4, Phlebitis sc ores were 0, 9, 15 and 12 for groups 1-4 respectively. Severe phlebiti s and line occlusion occurred more frequently in patients with a 15-cm catheter (group 3) and in those fed continuously over 24 h (group 4). These results suggest that mechanical trauma is an important factor i n the aetiology of infusion phlebitis. This can be minimized by reduci ng the time for which the vein wall is exposed to nutrient infusion an d by reducing the amount of prosthetic material within the vein.