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Here are more recent studies that elucidate that TPN can be given peripherally. Latest article in 2008, would this be reason enough to challenge the status quo? I have more.... 51 consecutive gastroenterological patients who required total parenteral nutrition (TPN) were entered into this study. Two patients were withdrawn because of specific nutritional requirements, leaving 49 patients for randomisation. 23 patients were allocated to receive peripheral parenteral nutrition (PPN) and 26 to receive feeding through a central venous line (CPN). There was no significant difference between the groups with respect to the median duration of feeding (9.4 ± 3.6 days; 12.0 ± 7.8 days) but significant morbidity occurred more frequently in the CPN group (11%) compared to the PPN group (0%). TPN by the designated route was not possible in 4 patients in the PPN group and in 3 of the CPN group. Of the 19 patients commenced on PPN, 13 continued without complication until resumption of oral feeding (median 10.7 ± 3.2 days); 6 of these patients had to be converted to central venous feeding for completion of their nutritional requirements. Of the 23 patients commenced on CPN, 21 completed their nutritional course (median 11.8 ± 5.3 days), 2 patients in the CPN group required conversion to PPN to complete their nutritional course. This study shows that PPN is a feasible, safe alternative to CPN in many patients. It is not necessary to subject all patients who require TPN to the risks and expense of central venous cannulation. Couse, N., Pickford, L., Mitchell, C., & Macfie, J. (1993). Total parenteral nutrition by peripheral vein -- Substitute or supplement to the central venous route? A prospective trial. Clinical Nutrition, 12(4), 213-216. doi:10.1016/0261-5614(93)90017-X ------------------------------------------------------------------------------------------------------------------------------------------------------------- IN 2008 STUDY: Historically, TPN has been administered by the central venous route because of the rapid development of thrombophlebitis when TPN solutions are administered into peripheral veins. Current awareness about the pathophysiology of peripheral vein thrombophlebitis and the use of a number of techniques that prevent or delay its onset mean that it is now possible to administer TPN via peripheral route. These techniques and the changes in the practice of TPN in recent years (e.g. 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 10-14 days. Gupta, K & Chopra, S. C.Total Parenteral Nutrition, Journal of Anaesthesia and Clinical Pharmacology 2008; 24(2): 137-146 ---------------------------------------------------------------------------------------------------------------------------------------------------------- Normally, infusion sets are changed every 24 h and infusion pump sets and flow meters, used to adjust infusion rates, are changed every 72 h. In the General Surgery Inpatient Unit, infusion fluids with osmolarity up to 900 mOsm/L are given through peripheral veins, whereas fluids with higher osmolarity are given through central veins. Some total parenteral nutrition products have a low level of osmolarity and are administered peripherally, in which case Abbott pump sets are used and changed every 24 h. Infusion fluids, drugs given, dates of catheterization, removals, and dressings are recorded. Uslusoy, E., & Mete, S. (2008). Predisposing factors to phlebitis in patients with peripheral intravenous catheters: A descriptive study. Journal of the American Academy of Nurse Practitioners, 20(4), 172-180. doi:10.1111/j.1745-7599.2008.00305.x --------------------------------------------------------------------------------------------------------------------------------------------------------- Peripheral versus central venous access PN is delivered by peripheral or central vein access, depending on the concentration of dextrose and consequent osmolarity of the solution. The maximum concentration of dextrose for peripheral venous access is 12.5%. A dextrose concentration greater than 12.5% has an acidic pH and can be irritating to the peripheral veins. In addition to dextrose, electrolytes and minerals added to the solution increase the osmolarity of the solution. Short term TPN for less than 3 days can be given via the peripheral line. Chaudhari, S., & Kadam, S. (2006). Total parenteral nutrition in neonates. Indian Pediatrics, 43(11), 953-964.

Abstract: Out of 60 patients undergoing surgery for colo-nectal cancer, 30 were given total parenteral nutrition (TPN) via a peripheral venous catheter (PVC), and 30 via a central venous catheter (CVC). All Patients were treated for 10 days perioperatively. There were no complications of the treatment by CVC. The treatment had to be interrupted in 11 (= 37%) of those receiving TPN via PVC, 4 because of general inconvenience, 7 because of transient pain in the infusion arm without any sign of phlebitis. 63% suffered no complications. The study shows that, with most patients, it is possible to give TPN with an osmolality around 1100 mOsm/kg for up to 10 days via peripheral veins. For TPN of short duration, or where the duration of treatment is uncertain, it is recommended to give TPN initially via peripheral venous catheter, unless a central venous catheter is indicated for other reasons. Reference Hoffman, E. (1998). A randomised study of central versus peripheral intravenous nutrition in the perioperative period. Clinical Nutrition, (8)4, 179-180.

Wound nurse here, just was wondering if you were all please with the wound vac company KCI. I been having some issues with the reps as well as the consultants. Maybe its just in my area, they are hard to deal with, I know they are having some issues internally, I check out this other board about pharm reps, http://www.cafepharma.com/boards/forumdisplay.php?f=257 it seems like the KCI workers are very upset. Sad, it is really affecting patient outcomes due to delays in service. Sometimes they dont even show up. I am also having difficulty sending patient home on the vac, some crazy paper work t fill out. So my question is it just in my area, because although quite expensive rental, most of my wounds heal nicely. Also, is there any other products out there like that VAC from KCI that works???? I tried a V1 bluesky vac and got some horrible outcomes. If anybody got some answers let me know.