Fine-bore peripheral catheters versus central venous catheters for delivery of intravenous nutrition

We present a descriptive study of 229 consecutive inpatients requiring intravenous nutrition. These patients received either complete peripheral intravenous nutrition via a fine-bore silicone catheter (n = 80) or short Teflon catheter (n = 15) or received conventional central intravenous nutrition (n = 134). Nutrient delivery was similar for both systems, providing 0.2-0.4 g N.kg-1 x day-1 and 0.13-0.15 mJ.kg-1 x day-1 from preparations containing 4.3 MJ/L total energy (65-75% lipid: 25-35% glucose for peripheral support and 100% glucose for central delivery) with 6 g N/L. We compared the incidence of catheter complication and the probability of catheter function over time for the peripheral and conventional central systems. Venous access complications were seen only with central venous catheterization (10.4%). Chemical phlebitis occurred in 17% of fine-bore catheters and 91.4% of Teflon catheters. The infective phlebitis rate of fine-bore silicone catheters was 1.02% and daily risk of phlebitis 0.016%, with no instance of device-related bacteremia or sepsis. Central-line microbial contamination (21.7%) and catheter-related sepsis (3%) were significantly greater (p < 0.0005, chi 2 goodness-of-fit test) than with fine-bore silicone and Teflon catheters. The probability of complication-free function against time was similar (0.75 < p < 0.90, log-rank test) in fine-bore silicone catheters and central venous catheters. We conclude that fine-bore silicone catheters provide long-term phlebitis-free delivery of complete peripheral intravenous nutrition.