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(BQ) Part 2 book "Nutrition support for the critically ill" presents the following contents: Access and complications of parenteral nutrition, surgical intensive care considerations, major infections and sepsis, organ failure and specialized enteral formulas, management of the obese patient | Chapter 7 Access and Complications of Parenteral Nutrition Dustin R. Neel Keywords Parenteral nutrition Venous anatomy Peripheral venous catheter Midline catheter Central venous catheter Peripherally inserted central catheter PICC Tunneled central venous catheter Implantable central venous port Thrombophlebitis Catheter-related infections Blood stream infections Pneumothorax Air embolism Catheter malposition Pinch-off syndrome Catheter occlusion Catheter thrombosis Hyperglycemia Hypoglycemia Hyperlipidemia Essential fatty acid deficiency Hepatic steatosis Nephromegaly Metabolic bone disease Refeeding syndrome Key Points Peripheral venous access is indicated for short-term parenteral nutrition in those with adequate veins and those whom can tolerate high volumes of low osmolality solutions but cannot tolerate short-term starvation. Peripheral parenteral nutrition is rarely necessary. The major complication of peripheral venous access is thrombophlebitis. Non-tunneled central venous catheters are placed via the Seldinger technique. The majority of complications including pneumothorax air embolism and bleeding occur during initial placement. These catheters may be used for short-term parenteral nutrition therapy. Peripherally inserted central catheters PICCs are indicated for intermediate-term access. Compared to central venous catheters they have a lower infection risk but a higher incidence of thrombophlebitis but dislodgement and difficulty with daily activities remain the major disadvantages. Tunneled central venous catheters are the preferred route of administration of parenteral nutrition in those patients that require it for an extended period of time. Occlusion and thrombosis results from a fibrin sheath formation which is a long-term complication of all access lines. Infection is the number one complication in central venous catheters with a wide range of presentations. Sepsis is associated with significant morbidity and mortality. The most commonly isolated
