To reduce the likelihood of
thrombophlebitis during
intravenous feeding through a peripheral vein, the osmolality of the
solution is usually reduced by disproportionately raising the
lipid content and lowering the
carbohydrate,
electrolyte, and aminoacid concentrations. The possibility that delivery system rather than feed is the main influence on the development of
thrombophlebitis was examined in a randomised comparison of a fine-bore
silicone catheter against a short '
Teflon'
cannula. The nutrient
solution given through a peripheral vein was a standard feed used for infusion into a central vein (osmolality 1250 mOsmol/kg, 13 g
nitrogen, 200 g
glucose [800 kcal], and
lipid emulsion [1000 kcal]). 27 patients received the infusion through a fine-bore
silicone rubber catheter (diameter 23 G, length 15 cm) and 23 through a
teflon catheter (diameter 20 G, length 3.2 cm). The median duration of feeding was 5 days in each of the two groups.
Thrombophlebitis developed in all patients in the
teflon group but in only 2 (7%) of the
silicone group. The first
silicone catheter for a patient lasted a median of 128.5 h, compared with 40 h for the first
teflon cannula (p less than 0.001). The results show that when a nutrient
solution of osmolality 1250 mOsmol/kg is delivered through a peripheral vein with an ultrafine-bore
silicone catheter, the risk of
thrombophlebitis is low. For many patients
intravenous feeding may thus be given through a peripheral instead of a central vein without compromising the nutritional adequacy of the feed.