Catheter Complications in Total Parenteral Nutrition

The complications related to central venous catheters for total parenteral nutrition were prospectively evaluated in 200 patients. Catheter sepsis was defined as an episode of sepsis, for which no anatomic locus could be identified, that resolved on removal of the catheter. The insertion of 355 catheters for 4492 days led to complications involving 4 per cent of the catheters and 6 per cent of the patients. Catheter sepsis was associated with 7 per cent of catheters and occurred in 11 per cent of patients. Eight cases of superior-vena-cava thrombosis and three of pulmonary embolism were found in 34 autopsied patients. Catheters used with strict aseptic technic were complicated by a sepsis rate of 3 per cent as compared to one of 20 per cent when breaks in the protocol were observed (p = 0.01). Thus, total parenteral nutrition can be employed with an acceptable risk, provided catheter care is according to protocol. (N Engl J Med 290:757–761, 1974)