Phlebitis is a major obstacle to successful and prolonged peripheral
parenteral nutrition (PPN). This study evaluated the effects of elective changes of the intravenous
cannula and cyclic infusion of PPN on the incidence and the severity of
phlebitis. 51 consecutive patients requiring PPN were randomised into three groups. Group 1 received PPN continuously through a line which was changed only on evidence of
phlebitis. In Group 2 intravenous lines were changed every 24h. Group 3 patients received PPN as a 12-h infusion after which the intravenous
cannula was withdrawn. All patients received 1800 non-
protein calories and 9.4g
nitrogen daily. Infusion sites were assessed daily for
phlebitis and this was scored using a modified Maddox scale. The mean (range) duration of PPN was 7.5 (1-13), 10.0 (2-42) and 8.2 (3-14) days in the three groups respectively. Severe
phlebitis occurred more frequently (p < 0.05) in Group 1 compared to Group 2 or Group 3. The overall incidence of
phlebitis assessed from the mean value of the Maddox scores for each group was highest in Group 1 and was significantly greater than that observed in either Group 2 (p < 0.05) or Group 3 (p < 0.001). Group 3 patients who received cyclic PPN had the lowest incidence of
phlebitis. The results of this study suggest that the incidence of infusion
phlebitis is minimised during PPN by the cyclic infusion of nutrient solutions.