Access routes for nutritional therapy

Enteral nutrition (EN) and total parenteral nutrition (TPN) may provide lif e-sustaining therapy for surgical patients. The duration of nutritional the rapy (enteral or parenteral) implies distinct access routes. We review the main aspects related to access routes for nutrient delivery. The enteral ro ute, whenever feasible, is preferred. Far EN lasting less than 6 weeks, nas oenteric tubes are the route of choice. Conversely, enterostomy tubes shoul d be used for longer-term enteral feeding and can be placed surgically or w ith fluoroscopic and endoscopic assistance. The first choice for patients w ho will not be submitted to laparotomy is percutaneous endoscopic gastrosto my. Postpyloric access, although not consensual, must be considered when th ere is a high risk of aspiration. For intravenous delivery of nutrients las ting less than 10 days, the peripheral route can be used. However, because of frequent infusion phlebitis, its role is still in discussion. Central ve nous catheters (CVCs) for TPN delivery may be (I) nonimplantable, percutane ous, nontunneled-used for a few days to 3 to 4 weeks; (2) partially implant able, percutaneous, tunneled-used for longer periods and permanent access; or (3) totally implantable subcutaneous ports-also used for long-term or pe rmanent access. The subclavian vein is usually the insertion site of choice for central venous catheters. Implantable ports are associated with lower rates of septic complications than percutaneous CVCs. The catheter with the least number of necessary lumens should be applied. Central venous nutrien t delivery can also be accomplished through peripherally inserted central c atheters, which avoid insertion-related risks.