Symposium on nutritional requirements of the surgical patient. 2. Peripheral parenteral nutrition.

During total parenteral nutrition hypertonic (25%) dextrose combined with 5% amino acid solutions must be used to achieve the necessary non-protein calorie/nitrogen ratio of 150:1. The resultant hyperosmolarity prohibits utilization of peripheral veins and makes cannulation of the subclavian vein mandatory. This exposes the patient to the risks of infection and technical complications, but these are uncommon and less important than the deleterious effects of chronic starvation. However, under certain clinical conditions it is possible to supply partial parenteral nutrition through peripheral veins, thereby avoiding the dangers of subclavian catheterization. Three such techniques--the intralipid system, protein sparing and infusion of the "P-900" solution--have been used with moderate success. The composition of the solutions and the techniques used are described.