Prolonged multipurpose venous access in burned patients: three years' experience with Hickman right atrial catheters.

We report the results of 3 years' experience with Hickman right atrial catheters in patients with 30-90% (mean, 52%) body surface burns. The catheters were used as multipurpose lines, including the administration of intravenous nutrition. The strict management protocol that was used is described: 76 catheters were inserted in 66 patients for a total of 9.5 patient years. Four patients had their catheters replaced because of fever but cultures were negative. Three patients had septicemia, from which two died. These results are similar to those reported following the use of rotating peripheral cannulae for fluid replacement only. However, Hickman right atrial catheters provide many nursing and patient advantages and are recommended to provide venous access for intravenous nutrition to patients with major burns.

Fine bore jejunostomy feeding following major abdominal surgery: a controlled randomized clinical trial.

A randomized controlled prospective clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy. Fifty patients undergoing surgery for gastrointestinal malignancy were randomly allocated into treatment and control groups. A low residue liquidized diet (Isocal) was administered to the patients in the treatment group. Control patients received routine intravenous therapy. Nutritional parameters (serum albumin, serum transferrin, serum prealbumin, weight, body fat and fat free mass) were measured pre-operatively and on the tenth postoperative day. Postoperative surgical complications were similar in both groups. There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding. Postoperative stay was significantly longer (P less than 0.01) in the treatment group patients. Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication-free, 'successful treatment', subgroup. It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications, its routine use cannot be recommended.