Best vein for total parenteral nutrition is
Ans. a (Subclavian vein). (Ref. Baily and Love surgery 25th/pg. 231)TOTAL PARENTERAL NUTRITIONDefined as the intravenous provision of all nutritional requirements, without the use of GIT.Indications:# Proximal intestinal fistula# Inflammatory bowel disease# Massive intestinal resection (especially if <100 cm of small bowel remains)# Ileus# Pancreatitis (severe)Preferred vein:# Peripheral line (for short period < 2 weeks)# Central line (for long period)Central venous route is chosen more commonly, and the catheter should be inserted via either subclavian, internal/ external jugular vein should be avoided as it is associated with high incidence of infection and thrombosis. The catheter tip should be in distal SVC to minimize risk of central venous or cardiac thrombosis.Complications of TPN:Catheter relatedFeeding Regimen related# Arterial, venous injuries and cardiac perforation and thrombosis# Hyperglycemia# Hypoglycemia# Brachial plexus and stellate ganglion injury# Hypertriglyceridemia# Pneumothorax# Hyperchloremic acidosis# Thoracic duct injury# Electrolyte imbalance# Air embolism# Trace element and vitamin deficiency# Catheter related infections # Catheter migration/embolus # Thrombotic catheter occlusion # SABE
Subclavian vein
Femoral vein
Brachial vein
Saphenous vein
Fluid & Electrolyte