I was questioned my ITU this morning re PN administration via CVC. I have always maintained that the CVC tip should be in the lower 1/3 SVC OR SVC/RA junction before administering hypertonic PN. CVC tip above this position we always prescribe peripheral i.e. hypotonic PN because of the associated risks of thrombosis although anywhere in the SVC is a large vessel and fast flowing blood.
what are you practices please? do you always advocate lower 1/3 SVC. Do you know % risk of thrombosis in SVC if tip higher than lower 1/3 SVC
I have contacted IR/ VAT but interested in your responses please.