Choosing the Right Central Venous Catheter for Parenteral Nutrition.

Abstract

The practice of safe and effective enteral nutrition (EN) and parenteral nutrition (PN) support is an important aspect in the abilities of a clinical gastroenterologist. Unfortunately, formal education programs for nutrition training in the course of a gastroenterology fellowship are often lacking. This leaves clinical gastroenterologists with the responsibility to safely deliver nutritional support to patients with little formal training. A critical step in the safe delivery of nutritional therapies to malnourished patients includes enteral access for EN and adequate venous access for PN. Here we provide the practicing physician useful guidance on the choice of venous access for PN support. The use of PN has come a long way from the first intravenous (IV) solutions composed of glucose, plasma and lipids in the early 1900s to the inception of modern formulas by Dudrick and colleagues at the University of Pennsylvania in 1968 (1). A main limitation to the use of PN early on was the lack of indwelling plastic catheters for safe administration of concentrated formulas. The administration of PN requires the use of a central venous catheter (CVC) with the tip at junction of the superior vena cava (SVC)/right atrium due to the hypertonic and acidic properties of the solution. Studies on the reactivity of plastic polymer-based catheters in tunneled subcutaneous tissue of dogs, led to the use of polyvinyl chloride (PVC) plastic catheters for the infusion of PN admixtures into the SVC of beagles (1). Subsequent advances in tunneled IV catheters and sterile placement of catheters resulted in reductions in complications of PN delivery. Parenteral nutrition is now the mainstay of shorter-term therapy (<3 months) for individuals with post-surgical anastomotic leaks/fistulas and longer-term therapy for short bowel/intestinal failure (IF). Initial choices in catheter type, placement technique, and location of placement continue to play an important role in lessening the risks associated with PN use.