PULMONARY-EMBOLISM AS A COMPLICATION OF LONG-TERM TOTAL PARENTERAL-NUTRITION

Although much has been written concerning the complications of long-te rm total parenteral nutrition, little or no mention of pulmonary embol ism is made in the literature. We present two patients maintained on h ome total parenteral nutrition who suffered pulmonary emboli, one whil e receiving standard heparin therapy. No potential source other than t heir indwelling total parenteral nutrition catheter was identified. St udies have revealed catheter-related thrombosis in up to 50% of patien ts with indwelling central venous catheters. Although early surgical l iterature suggested that upper extremity deep vein thromboses rarely e mbolize, more recent investigations have proven this false. In fact, t he risk of pulmonary emboli appeared to be greatest in those thrombi t hat were catheter related. Because of this risk, we suggest a hypercoa guable work-up in any patient with a history of recurrent thrombosis. Heparin is central to the current preventive regimens; however, furthe r study is needed to determine the most efficacious dose. Future devel opment of less thrombogenic catheters will also be of assistance. Thro mbolytic agents currently have an expanding role in the treatment of t hrombotic complications. Whether they will have a future role in preve ntion remains unknown.