Venous access for parenteral nutrition-strategies to minimse catheter-related infection Ng Kim Swee Senior Consultant Anesthesiologist, Dept. of Anaesthesia, Changi General Hospital, Singapore The preferred route of nutritional support is enteral. Unfortunately, there remain certain patients who can only be supported by the parenteral route. In order to deliver adequate nutrients, parenteral nutrition (PN) solutions are concentrated and hyperosmolar. To deliver such a solution safely, central venous access is required. The patient on PN is therefore at risk of catheter-related infection (CRI). A review of factors that contribute to CRI and the mechanisms involved in CRI allow the formulation of some strategies to minimise this undesirable and serious complication. Silicone and polyurethrane catheters have been shown to carry a significantly lower rate of CRI compared to catheters made of polyvinylchloride or polyethylene. With regards to site for central venous access, the femoral and internal jugular routes have been found to carry a higher rate of CRI compared to the subclavian and peripheral arm routes. In a prospective randomized trial, Raad et al showed that CRI was significantly reduced when maximal sterile barrier was observed during line insertion. It has also been shown by Maki et al that site preparation using 2% chlorhexidine resulted in less CRI compared to 10% povidone-iodine and 70% alcohol. Various studies have demonstrated a relationship between duration of central line and incidence of CRI. Yet, a study by Cobb et al did not show a reduction in CRI with scheduled replacement of central catheter at 3-day intervals. Colonisation of skin insertion site and catheter hubs are the usual source of CRI. These two areas remain the focus of strategies to minimise the incidence of CRI. From "The 7th Congress of the PENSA Abstract Book " Bali, Indonesia, August 24-26, 2001 Page : 38