Venocutaneous fistula: a central venous catheter--associated complication

Central venous catheter placement for parenteral feeding, whether short-term as in acute hospital care or long-term as in home total parenteral nutrition (TPN), is a well-established intervention in the patient who cannot eat. Access to the central venous system in the majority of the cases is gained by insertion of the catheter into either the subclavian or jugular vein. Associated with central venous catheters is the possible development of mechanical and septic complications, the incidence of which depends upon the skill, experience, and commitment of both the patient and the nutrition support team. A case report is presented in which a woman developed a venocutaneous fistula due to a chronic indwelling right internal jugular central catheter placed for long-term home nutritional support. The patient's medical history, management of her catheter, and proposed etiology for this problem are discussed, and complications of central access and TPN usage are addressed.