Incidence of phlebitis in peripheral parenteral nutrition: effect of the different nutrient solutions

To determine the influence of peripheral parenteral nutrition (PPN) on the incidence of phlebitis and the effect of simultaneous infusion of lipid emulsion, 68 surgical patients were assigned randomly to 3 nutrition groups: (1) amino-acid 4% solution and dextrose 8% (AA + DX) + Intralipid (IL) 10% in the ratio 1.5:1 (2) AA + DX and IL 20% in the ratio 3:1 (3) AA + DX alone. Group 4 (control group) consisted of 25 patients receiving maintenance solutions and iso-osmotic drugs. No filters were used. The cannulae were studied for 72 hours and the cannula sites were evaluated daily for phlebitis. Mean age of patients was 52.3 +/- 17.7 years, with a similar sex ratio in the 4 groups. One hundred and twenty-five cannulae were studied. At 72 h, the following cumulated phlebitis rates were recorded: 22% in Group 1 (712 mOsm/L), 48% in Group 2 (802.5 mOsm/L), 44% in Group 3 (920 mOsm/L) and 26% in Group 4 (260-314 mOsm/L). The phlebitis incidence was similar in groups 1 and 4 (control) throughout the study. Both Groups 2 and 3 had higher phlebitis rates on days 2 and 3 (II: p < 0.05, III: p < 0.01). It is concluded that PPN with simultaneous IL 10% in the ratio 1.5:1 is no more phlebogenic than the usual maintenance solutions during the first 72 h. This is probably due to the lower osmolality and lower DX and K concentrations of the solution with IL 10%. Intralipid 20% does not have the same protective venous effect. The lower complication rate, the limited need for nursing, and lower costs compared to central parenteral nutrition, make PPN a safe nutrition technique for up to 10 days in patients needing no volume restriction.