A randomised study of the effects of osmolality and heparin with hydrocortisone on thrombophlebitis in peripheral intravenous nutrition

Abstract

Intravenous nutrition administered via the central route incurs both the risks of catheter insertion and catheter related sepsis. Peripheral intravenous nutrition avoids these risks but is associated with a high risk of thrombophlebitis. We undertook a study to look at the incidence of thrombophlebitis caused by the infusion of a) a ‘ready to use’ mixture (Vitrimix KV) with an osmolality of 1130 mOsmol/kg, b) Vitrimix KV plus heparin and hydrocortisone, and c) a feed, with an osmolality of 700 mOsmol/kg, with heparin and hydrocortisone, to investigate the effects of the addition of heparin and hydrocortisone and the effect of osmolality on the incidence of thrombophlebitis. The addition of heparin (500 u/l) and hydrocortisone (5 mg/l) to Feed A significantly reduced the daily risk of thrombophlebitis from 0.43 to 0.11 episodes per patient, p < 0.01. A reduction in the osmolality resulted in a further fall in the incidence of thrombophlebitis to 0.04 episodes per patient with a significant increase in the median life span of the cannula from 26 h to 86 h, p < 0.02. Our data show that a low incidence of thrombophlebitis can be achieved by the use of a low osmolality feed with heparin and hydrocortisone. It is recommended that peripheral intravenous nutrition be used in patients who require nutritional support for less than 10 days.