A critically ill patient in the surgical ICU is unable to tolerate enteral feeding due to an enterocutaneous fistula with high output. He requires total parenteral nutrition. Which vein is the preferred access site for long-term TPN?

• A Cephalic vein
• B Femoral vein
• C Antecubital vein via peripheral cannula
• D Subclavian or internal jugular vein via central venous catheter ✓

Explanation

Total parenteral nutrition requires central venous access (subclavian, internal jugular, or PICC line) because of the high osmolality and concentration of TPN solutions, which would cause phlebitis and thrombosis in peripheral veins. The subclavian or internal jugular route allows access to the superior vena cava where high flow rapidly dilutes the solution. Femoral access is associated with higher infection risk and is generally avoided for TPN. Peripheral lines are suitable only for short-term, lower-concentration solutions.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.