Total parenteral nutrition via a peripheral vein: A comparison of heparinised and non-heparinised regimens

The addition of heparin at 1 IU/ml to TPN infusate produced a marked extension of the survival of the infusion sites, and this technique warrants further investigation with other peripheral regimens.

Abstract

Abstract Administration of total parenteral nutrition solutions via a peripheral vein is an attractive concept. An ideal regimen would meet the requirements of moderately catabolic patients and would contain about 14g of nitrogen and 2200kcals. The feasibility of administering such a regimen was examined in a study at Hammersmith hospital, London. To prolong vein survival and minimise the risk of phlebitis, all patients had a glyceryl trinitrate patch and twice daily hydrocortisone cream applied to the infusion site. Patients were randomised to receive either heparinised or non-heparinised TPN at a concentration of 1 IU/ml. Sixteen patients were recruited to the study of whom nine received heparin in their TPN. The end point was determined as occurring when the cannula was removed electively or accidentally, or when phlebitis around the cannula site necessitated removal. Infusions ending in phlebitis or tissuing were counted as true failures while cannulae electively withdrawn or pulled out were treated as censored data. The median survival time of infusion sites receiving heparinised TPN was 69 hours while the median survival time of sites receiving TPN only was 31 hours. Life table analysis was carried out on the duration of patency of individual cannulation sites. Comparison of the two groups using the logrank test showed a significant difference (p=0.013). Thus, the addition of heparin at 1 IU/ml to TPN infusate produced a marked extension of the survival of the infusion sites. This technique warrants further investigation with other peripheral regimens.