Intravenous nutrition administered via the central route incurs both the risks of
catheter insertion and
catheter related
sepsis. Peripheral intravenous nutrition avoids these risks but is associated with a high risk of
thrombophlebitis. We undertook a study to look at the incidence of
thrombophlebitis caused by the infusion of a) a 'ready to use' mixture (Vitrimix KV) with an osmolality of 1130 mOsmol/kg, b) Vitrimix KV plus
heparin and
hydrocortisone, and c) a feed, with an osmolality of 700 mOsmol/kg, with
heparin and
hydrocortisone, to investigate the effects of the addition of
heparin and
hydrocortisone and the effect of osmolality on the incidence of
thrombophlebitis. The addition of
heparin (500 u/l) and
hydrocortisone (5 mg/l) to Feed A significantly reduced the daily risk of
thrombophlebitis from 0.43 to 0.11 episodes per patient, p < 0.01. A reduction in the osmolality resulted in a further fall in the incidence of
thrombophlebitis to 0.04 episodes per patient with a significant increase in the median life span of the
cannula from 26 h to 86 h, p < 0.02. Our data show that a low incidence of
thrombophlebitis can be achieved by the use of a low osmolality feed with
heparin and
hydrocortisone. It is recommended that peripheral intravenous nutrition be used in patients who require
nutritional support for less than 10 days.