A prospective and randomised study comparing the incidence of infusion phlebitis during continuous and cyclic peripheral parenteral nutrition

Phlebitis is a major obstacle to successful and prolonged peripheral parenteral nutrition (PPN). This study evaluated the effects of elective changes of the intravenous cannula and cyclic infusion of PPN on the incidence and the severity of phlebitis. 51 consecutive patients requiring PPN were randomised into three groups. Group 1 received PPN continuously through a line which was changed only on evidence of phlebitis. In Group 2 intravenous lines were changed every 24h. Group 3 patients received PPN as a 12-h infusion after which the intravenous cannula was withdrawn. All patients received 1800 non-protein calories and 9.4g nitrogen daily. Infusion sites were assessed daily for phlebitis and this was scored using a modified Maddox scale. The mean (range) duration of PPN was 7.5 (1–13), 10.0 (2–42) and 8.2 (3–14) days in the three groups respectively. Severe phlebitis occurred more frequently (p < 0.05) in Group 1 compared to Group 2 or Group 3. The overall incidence of phlebitis assessed from the mean value of the Maddox scores for each group was highest in Group 1 and was significantly greater than that observed in either Group 2 (p < 0.05) or Group 3 (p < 0.001). Group 3 patients who received cyclic PPN had the lowest incidence of phlebitis. The results of this study suggest that the incidence of infusion phlebitis is minimised during PPN by the cyclic infusion of nutrient solutions.