ADMINISTRATION OF PERIPHERAL PARENTERAL-NUTRITION - A PROSPECTIVE-STUDY COMPARING ROTATION OF VENOUS ACCESS SITES WITH ULTRAFINE CANNULAS

Peripheral veins have been used successfully for patients requiring sh ort- to medium-term total parenteral nutrition. This study prospective ly compares two methods of peripheral parenteral nutrition (PPN). Fort y-six patients requiring parenteral nutrition (PN) were identified pro spectively. Fifty courses of PPN were prescribed using a standardized PPN formula of 9.3 g nitrogen, 1400 kCal, 2500 mi (KABI II, Pharmacia) . Patients were randomized to receive PPN via 23G, 15 cm flexane cathe ters (Nutriline) inserted into an antecubital vein which remained in-s itu with a continuous infusion over 24 h, or to receive 12-h cyclical infusions through peripherally sited 18G catheters (Venflon) which wer e removed postinfusion and reinserted into the contralateral forearm o n alternate days. Data collected included duration, complications and cost of materials for each prescribed course. A scoring system to dete rmine patient anxiety and depression and a questionnaire regarding pat ients' perspectives were evaluated. Fifty courses were prescribed, 26 by rotation of veins (RV) and 24 by Nutriline (N). Mean duration of fe eding was 7.9 and 8.6 days, respectively; cost of materials were compa rable 6.48/day (RV) vs 5.17/day (N); 2 RV patients failed to complete their course (no access [P < 0.05], whilst 9 N patients failed to comp lete their course (4 severe phlebitis, 2 no venous access, 2 septicaem ia, 1 dislodged). Five patients required CPN (RV, N 3) while 4 remaini ng patients were fed by an alternative PPN method. The overall inciden ce of anxiety was 20% and of depression 16%, with no significant diffe rence between groups. The majority of patients (87%) found mobility re stricted. Twelve-hourly infusions via alternate forearm veins were sig nificantly more successful than continuous infusions via Nutriline, bo th in terms of completion of the prescribed course and less venous mor bidity. This study confirms that rotation of forearm veins allows affo rdable and successful PN administration to the majority of patients, w ith low PN-related morbidity.