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We present a descriptive study of 229 consecutive inpatients requiring intravenous nutrition. These patients received either complete peripheral intravenous nutrition via a fine-bore silicone catheter (n = 80) or short Teflon catheter (n = 15) or received conventional central intravenous nutrition (n = 134). Nutrient delivery was similar for both systems, providing 0.2-0.4 g N.kg-1 x day-1 and 0.13-0.15 mJ.kg-1 x day-1 from preparations containing 4.3 MJ/L total energy (65-75% lipid: 25-35% glucose for peripheral support and 100% glucose for central delivery) with 6 g N/L. We compared the incidence of catheter complication and the probability of catheter function over time for the peripheral and conventional central systems. Venous access complications were seen only with central venous catheterization (10.4%). Chemical phlebitis occurred in 17% of fine-bore catheters and 91.4% of Teflon catheters. The infective phlebitis rate of fine-bore silicone catheters was 1.02% and daily risk of phlebitis 0.016%, with no instance of device-related bacteremia or sepsis. Central-line microbial contamination (21.7%) and catheter-related sepsis (3%) were significantly greater (p < 0.0005, chi 2 goodness-of-fit test) than with fine-bore silicone and Teflon catheters. The probability of complication-free function against time was similar (0.75 < p < 0.90, log-rank test) in fine-bore silicone catheters and central venous catheters. We conclude that fine-bore silicone catheters provide long-term phlebitis-free delivery of complete peripheral intravenous nutrition.

We measured the temperature of 10 previously refrigerated parenteral-nutrition solutions (PN solutions) at the end of a standard intravenous-infusion set (IIS) (Intrafix, 145 cm long), an IIS with a mechanical device to control the flow of the solution (Dial-a-Flow, 226 cm long), and an IIS to be used with a volumetric infusion pump (Infusomat, 259 cm long). The temperature of the PN solution just after taking it out of the refrigerator was 6.0 +/- 0.8 degrees C (mean +/- SD), and that of the room was 24.2 +/- 0.7 degrees C. We recorded the temperature again at the end of the IIS after draining it freely, i.e., until there was no air inside the set (time 0), after 5, 10, and 15 min of infusion at 100 ml/h. After 15 min, the temperature at the end of the Intrafix set did not statistically differ (P less than 0.05) from room temperature. With Dial-a-Flow, the temperature of the solution was not statistically different from room temperature at any time. Finally, with Infusomat, the temperature was statistically different from that of the room for the first 5 min. We thus conclude that refrigerated PN solution can be administered to patients without having to warm it whenever an IIS is longer than 145 cm and flow not exceeding 100 ml/h is used. Adverse reactions sometimes observed in patients at the beginning of the administration of PN solution cannot, in our opinion, be attributed to the low temperature of the solution.

A total of 18 adult dogs were kept on peritoneal nutrition (PeN) for 30 days via peritoneal catheter. Eleven dogs were put on peritoneal nutrition immediately, receiving a caloric rate of 45 kcal/kg per day, half of which was supplied by glucose and the other half by 20% intralipid, along with 0.5 g/kg per day of protein, as well as ions, trace elements, and vitamins. Two-thirds of the glucose was administered separately. Seven other animals underwent an 80% resection of the small intestine and were kept on special oral nutrition for 6 weeks. After this time, peritoneal nutrition was applied with the same caloric rate as in the previous group but with a protein dose of 1 g/kg per day and administration of the nutrients every 6 hours. We found two cases of peritonitis in the group without intestinal resection, whereas no infectious outbreaks occurred in the group subjected to intestinal resection. This group showed an exacerbated nutritional state, with a consequently greater loss of weight and albumin and a negative nitrogen balance. The peritoneal membrane showed signs of cellular hyperplasia and hypertrophy following peritoneal nutrition. These phenomena disappeared 1 month after PeN was terminated.