Incidence and prevention of thrombosis of the subclavian vein during total parenteral nutrition.

In this study, we were able to document by radionuclide venogram the presence of thrombosis of the subclavian vein in seven of 22 patients receiving standard total parenteral infusions. By adding 3,000 U.S.P. units of heparin to each liter of infusate, we were able to reduce the number of instances of thrombosis to two in 24 patients. Although none of the patients in the heparin therapy group experienced laboratory or clinical manifestations of anticoagulation, we suggest that further studies be done to investigate the reduced heparin concentrations to determine the lowest effective level. Based upon these observations, we currently recommend that 3,000 U.S.P. units of heparin be added to each liter of total parenteral nutrition solution infused through a subclavian venous catheter.