Central venous alimentation: a prospective study of the frequency of metabolic abnormalities among medical and surgical patients.

Many studies have described the frequency of septic and technical complications of central venous alimentation (CVA), but metabolic complications of CVA have received scant attention. Among 100 consecutive medical and surgical patients receiving CVA under routine hospital conditions, at least one severe biochemical defect (above the 99th percentile ranking) was observed in 63 cases (63%). Uncontrolled hyperglycemia (defined as blood glucose greater than 300 milligrams per deciliter after more than 48 hours of CVA) was present in 47 individuals. Hypophosphatemia (serum phosphorus less than 2.0 milligrams per deciliter) occurred in 30 and was life-threatening (less than 1.0 milligrams per deciliter) in 6. Although liver function tests (LFT) remained stable or improved in 26% of the 34 evaluable subjects, 74% showed deterioration in one or more tests, and 35% showed deterioration in two or more tests. Deterioration was defined as an abnormal result that was 50% or more above baseline in patients having weekly LFT and CVA for a minimum of 10 days. The study involved 1378 patient-days of CVA, a mean of 14 days per patient with a range of 2 to 70 days, and an average of 2.2 catheter insertions per patient. Technical complications occurred in 3% and septic complications occurred in 4% of 220 catheter insertions. There was no significant difference in the type or frequencies of metabolic, septic, and technical complications occurring between medical and surgical patients. The findings suggest that many reports concerning septic and technical complications of CVA have promoted awareness of the problem and served to minimize these risks. However, this study demonstrates that serious metabolic complications of CVA occur at an unexpectedly high rate and that greater attention should be directed at their prevention.