Total parenteral nutrition, peripherally inserted central catheters, and tip position: potential for errors.

摘要

The safety of using peripherally inserted central catheters (PICC) for total parenteral nutrition (TPN) has been demonstrated by several studies. Outpatient TPN either at home or at a chronic care facility is commonplace. However, the possibility of catheter tip migration to inappropriate sites for delivery of TPN can occur with potential for serious consequences. A 60-year-old gentleman underwent repair of a ruptured abdominal aortic aneurysm complicated by the need for open abdomen due to bowel edema. He required TPN for nutritional support. Initial treatment was at a tertiary care center, but he was later referred to a home health agency for home TPN. He developed severe headaches while on TPN and chest X-ray showed the tip of the PICC line in the internal jugular site (Fig. 1). Original placement was appropriate. His headaches stopped once TPN was discontinued and a new line was later inserted. There was no change in the external markings of the PICC.