Peripheral venous complications of a hyperosmolar (960 mOsm) nutritive mixture: The effect of heparin and hydrocortisone. A multicenter double-blinded random study in 98 patients.

Peripheral intravenous nutrition with hyperosmolar solutions usually results in a high rate of venous complications. The aim of this multicenter double blind randomised study in 98 patients has been to measure: (a) tolerance by the peripheral veins being perfused with a protein-glucose-lipid nutritive mixture of 960 mOsm/l (group A, n = 33), (b) the protective effect of the additive to the nutritive mixture of either heparin: 1000 IU/1 (group B, n = 32) or heparin with hydrocortisone (5 mg/l) group C, n = 33). Tolerance by the veins was evaluated on a single vein site during a 48 h perfusion with 21 per day. The following complications: oedema, erythema, induration, thrombophlebitis led to the interruption of the perfusion. The rate of interruptions of perfusions for total venous complications and for thrombophlebitis has been respectively: at 24 h, in group A: 39 and 15%, in group B: 6 and 3%, in group C: 12 and 0%; at 48 h: in group A: 82 and 42%, in group B: 53 and 18%, in group C: 36 and 6%. Venous complication rates for 24 and 48 h were significantly lower in groups B and C (p<0.05) than in group A and there was no inter group difference between groups B and C. These results suggest that peripheral venous nutrition infusing 14.1 g of nitrogen and 8.5 MJ per day can be performed with a hyperosmolar solution of 960 mOsm/1, if that heparin be added to the nutritive mixture and the perfusion site be changed daily. Under these conditions the observed venous complications rate is equal to or less than 6% of cases.

[The venous route in total parenteral nutrition of the adult patient (author's transl)]. / La voie veineuse pour la nutrition parentérale totale de l'adulte.

Total parenteral nutrition (T.P.N.) takes presently an important place in the therapeutic methods. Nevertheless multiple complications, directly related to the venous route can constitute a limiting factor in the application of such procedures. Therefore complications such as sepsis and venous thrombosis must be prevented during T.P.N. Some conditions issued from our experiences and from the results in the literature can be now well defined: 1) Surgical catheterization of the vein in cases of long term T.P.N. and transcutaneously in cases of short term T.P.N. with in all cases a long subcutaneous way of the catheter. 2) Silastic catheter must be systematically used. 3) The intravenous way of the catheter must be as short as possible. 4) Nutrients must be strictly infused in the superior vena cava. 5) The utilisation of nutritive mixtures must be prefered if possible. 6) Handling of the infusion line must be avoided. Finally the management of T.P.N. in the best conditions requires a specialized staff.