A case presentation: precipitate in the central venous line: what went wrong?

Occlusion of small-bore central venous lines with a calcium/phosphate precipitate during medication administration is a concern for NICUs attempting to provide adequate nutrition for extremely low birth weight infants. This case presentation provides data for and reports the investigation of one central venous line precipitation incident. It also examines calcium/phosphate solubility in parenteral nutrition solutions and explores the effects of heparin, aminophylline, and L-cysteine on solubility. The role of L-cysteine as an essential amino acid for neonates is addressed, and recommendations for reducing the likelihood of a central venous line occlusion are given.