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Vascular Access Devices


Shelby Yaceczko, DCN, RDN-AP, CNSC, CCTD


The appropriate selection, placement, and ongoing management of the vascular access device (VAD) is essential to minimizing or avoiding potential complications with parenteral nutrition (PN) infusion ther- apy. PN solutions can be delivered through peripheral or central veins, depending on the osmolarity of the solution. The threshold for peripheral solutions is generally considered less


than 900 mOsm/ L, although some evidence suggests a more conserva- tive limit, indicating that endothelial damage may occur with osmolarity as low as 600 mOsm/ L.1,2


The osmolarity limit of peripheral access sites


can be a limiting factor to providing full nutritional requirements, as the volume a patient may need to reach their estimated nutrient needs can be quite high. This is especially important to consider in patients who have difficulty achieving fluid balance or who require fluid restriction for clini- cal reasons. Because of the high risk for phlebitis, peripheral catheters are intended for short-term use, usually less than 4 days.1 When PN is infused via central access, it is rapidly diluted by the


high blood flow in large vessels. Central venous access with the tip of the catheter positioned in the superior vena cava (SVC) proximal to the right atrium of the heart, or at the junction of the SVC and right atrium (known


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