Peripheral intravenous nutrition therapy: outpatient, office-based administration

The use of peripheral intravenous nutrition (PIN) has been growing in recent years due to the increase in awareness of the pathophysiological mechanisms of peripheral vein thrombophlebitis, as well as the availability of techniques to prevent or retard its onset. With the increase in public and medical practitioner awareness of the importance of nutritional interventions in health and disease, more outpatient-based PIN therapy is being performed. Outpatient, office-based PIN has unique features including high osmolality, high infusion rates, and short infusion duration.

Previous intravenous nutrition studies were used to estimate safety parameters for outpatient, office-based PIN.

Osmolalities of the infusion can approach 1000 mOsm/L if the duration of the infusion is only several hours. The infusion should be diluted to reduce the osmolality, even if an increase in infusion rate is necessary. Duration of infusion should be less than three hours to reduce the time the irritating mixture contacts the vein wall. This requires high (150 - 330 mL/hour) infusion rates. The largest vein, and smallest and shortest catheter possible to achieve the infusion rate desired should be used, with in-line filtration of at least 0.45mm. The cannula should be removed at the first sign of pain or redness. Standard procedures to reduce infection risks should be followed.