Safety and efficacy of total parenteral nutrition delivered via a peripherally inserted central venous catheter

Abstract

Central venous catheters for total parenteral nutrition (TPN) have traditionally been inserted via direct cannulation of the subclavian vein, but this technique requires physician participation and is associated with well-described complications. We report the single largest institutional experience with peripherally inserted central venous catheters (PICC lines) used exclusively for TPN in non-intensive care unit patients. From July 1991 to March 1994, 135 PICC lines were placed in 126 patients via the antecubital vein, advanced into the central venous system, and used only for TPN. Complication rates were determined and compared with those for TPN administered through a subclavian vein-inserted central catheter. Patient demographics were similar in each group with respect to age, type of disease process, acuity of illness, and indications for nutrition support. A cumulative number of 1381 TPN days (mean = 11 days per patient) comprised the PICC line experience. Comparison was made with 135 successive standard (subclavian) central lines inserted in 105 patients for TPN administration (1056 TPN days, mean = 10 days per patient). There was no difference in the overall rate of complications between the two groups. There were no major complications that prolonged hospitalization (eg, catheter-related sepsis or pneumothorax) in the PICC group compared with three such complications in the standard group. PICC lines can be used safely and effectively for TPN and are associated with an acceptable rate of complications.

Central Venous Access in the Home Parenteral Nutrition Population–You PICC

“…These complications stimulated interest in the use of PICC as a means of CV access without the risk of major insertion-related complications. 7 However, the initial experience with PICC in the hospital setting was an increased incidence of phlebitis, thrombosis, or sepsis. 8 -11 More recent hospital-based studies comparing the use of a blind, bedside CV catheter placement vs blind, bedside PICC placement demonstrated a similar rate of infection between the 2 groups.…”

“…8 -11 More recent hospital-based studies comparing the use of a blind, bedside CV catheter placement vs blind, bedside PICC placement demonstrated a similar rate of infection between the 2 groups. 7,12,13 These studies specifically evaluated the use of PICC vs OCVAD for PN in the hospitalized patient population, generally a short-term PN environment. There are no hospitalbased studies comparing the infection rates of tunneled CV catheters and ports compared with tunneled PICC placed with fluoroscopic guidance for PN delivery.…”

Peripherally Inserted Central Catheters May Lower the Incidence of Catheter-Related Blood Stream Infections in Patients in Surgical Intensive Care Units

“…Recent data indicate that in critically ill patients, the rate of PICC infections is 2.1/1,000 catheter-days [20]. Other evidence suggests that, despite the low reported incidence of PICC-related infections, there is no difference in infectious complications compared with CVCs [21][22][23][24]. However, this evidence was presented in the context of short-term use, as patients requiring long-term access were excluded from the comparison.…”

Iatrogenic Chylothorax Due to Pleural Cavity Extravasation of Total Parenteral Nutrition in Two Adults Receiving Nutrition through a Peripherally Inserted Central Catheter

“…Peripherally inserted central catheter use has become more popular in recent years, especially to deliver total parenteral nutrition (TPN), as their overall complication rates are approximately equivalent to those of other central access devices. [11][12][13][14][15] We report 2 cases of PICC-associated central extravasation of TPN related to repositioning and subsequent migration of the PICC. In both instances, signifi cant morbidity (including transfer to the intensive care unit [ICU]) occurred and effusions were initially diagnosed as chylothorax by radiologic evidence.…”