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Complications of central vein nutritional support occur in up to 50% of patients. Although most are minor and easily managed, significant complications develop in approximately 5% of patients. Complications of central vein nutritional support can be divided into catheter-related complications and metabolic complications.

Catheter-related complications can occur during insertion or while the catheter is in place. Pneumothorax, hemothorax, arterial laceration, air emboli, and brachial plexus injury can occur during catheter placement. The incidence of these complications is inversely related to the experience of the clinician performing the procedure but occur in at least 1–2% of cases even in major medical centers. Each catheter placement should be documented by chest radiograph prior to initiation of nutritional support.

Catheter thrombosis and catheter-related sepsis are the most important complications of indwelling catheters. Patients with indwelling central vein catheters in whom fever develops without an apparent source should have their lines changed over a wire or removed immediately, the tip quantitatively cultured, and antibiotics begun empirically. Quantitative tip cultures and blood cultures help guide further antibiotic therapy. Catheter-related sepsis occurs in 2–3% of patients even if optimal efforts are made to prevent infection.

Metabolic complications of central vein nutritional support occur in over 50% of patients (Table 29–5). Most are minor and easily managed, and termination of support is seldom necessary.

Table 29–5.Metabolic complications of parenteral nutritional support.
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Kovacevich  DS  et al. American Society for Parenteral and Enteral Nutrition guidelines for the selection and care of central venous access devices for adult home parenteral nutrition administration. JPEN J Parenter Enteral Nutr. 2019;43:15.
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