Which of the following statement(s) concerning intravenous nutritional support is/are true?
A. Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis B. A major disadvantage of the peripheral technique is limited caloric delivery C. If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein is the most suitable site D. Venous thrombosis is an uncommon complication for long-term central vein catheterization
A major disadvantage of the peripheral technique is limited caloric delivery-although peripheral access can be used for intravenous nutrition, the major disadvantage of this technique is limited caloric delivery to meet catabolic demands within tolerated fluid limits. infusion of glucose (up to 10%), amino acid solutions, and fat emulsions can be administered peripherally but these solutions must be nearly isotonic to avoid peripheral vein sclerosis. the preferred method of access for total parenteral nutrition is into the superior vena cava by cutaneous cannulation of the subclavian vein. alternative sites include the internal and external jugular vein but the catheter exiting from the neck region makes it more difficult to secure and maintain a sterile dressing. complications from long-term central venous catheterization include venous thrombosis and venous catheter-related infection. thrombosis of central vessels is a complication which is often overlooked. the clinical suspicion of subclavian vein thrombosis is only about 3%, whereas studies that use phlebography or radionucleotide venography indicate the incidence is as high as 35%.