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. ||Download (.pdf) Table 29–5. Metabolic complications of parenteral nutritional support.
|Complication ||Common Causes ||Possible Solutions |
|Hyperglycemia ||Too rapid infusion of dextrose, “stress,” corticosteroids ||Decrease glucose infusion; insulin; replacement of dextrose with fat |
|Hyperosmolar nonketotic dehydration ||Severe, undetected hyperglycemia ||Insulin, hydration, potassium |
|Hyperchloremic metabolic acidosis ||High chloride administration ||Decrease chloride |
|Azotemia ||Excessive protein administration ||Decrease amino acid concentration |
|Hyperphosphatemia, hypokalemia, hypomagnesemia ||Extracellular to intracellular shifting with refeeding ||Increase solution concentration |
|Liver enzyme abnormalities ||Lipid trapping in hepatocytes, fatty liver ||Decrease dextrose |
|Acalculous cholecystitis ||Biliary stasis ||Oral fat |
|Zinc deficiency ||Diarrhea, small bowel fistulas ||Increase concentration |
|Copper deficiency ||Biliary fistulas ||Increase concentration |
et al. Rate of catheter-related bloodstream infections between tunneled central venous catheters versus peripherally inserted central catheters in adult home parenteral nutrition: a meta-analysis. JPEN J Parenter Enteral Nutr. 2019;43:41.
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.
et al. Infectious complications in home parenteral nutrition: a long-term study with peripherally inserted central catheters, tunneled catheters, and ports. Nutrition. 2019;58:89.