First choice for total parenteral nutrition: the peripheral route.

Historically, total parenteral nutrition (TPN) has been administered by the central venous route because of the rapid development of thrombophlebitis when TPN solutions are administered into peripheral veins. The insertion and placement of central venous catheters is, however, associated with morbidity and mortality and is the main cause of TPN-related complications. By avoiding central venous catheterization, TPN can be made safer. Current awareness about the pathophysiology of peripheral vein thrombophlebitis and the use of a number of techniques that prevent or delay onset of peripheral vein thrombophlebitis mean it is now possible to administer TPN via the peripheral route. These techniques and changes in the practice of TPN in recent years (eg, reduction of caloric loads and use of lipid emulsions) mean peripheral parenteral nutrition is a technique that is now applicable to the majority of hospitalized, nutritionally compromised patients for whom intravenous feeding is anticipated for less than 10 to 14 days.