肠外营养静脉输注途径的规范应用

Choice of intravenous infusion route for parenteral nutrition

肠外营养的静脉输注途径分为周围静脉和中心静脉两种途径.周围静脉是肠外营养支持首选的输注途径;高渗透压（＞ 900 mOsm/L）或需要长期接受肠外营养（＞14 d）建议通过中心静脉输注.经皮穿刺中心静脉置管适合危重症患者,锁骨下静脉途径是首选,但使用时间不建议超过30 d;经外周静脉置入中心静脉导管有低穿刺风险和较少感染并发症,是国内指南推荐适合老年患者肠外营养支持的首选入径;静脉输液港可增加患者日常生活自由度,不需换药,可以沐浴,显著提高生活质量,为长时间接受静脉输液治疗包括肠外营养患者提供了可靠的入径.选择肠外营养支持静脉输注途径时,应考虑患者的病情和主观愿望以及肠外营养时间等因素,规范的护理导管维护技术是安全使用的保障.

Parenteral nutrition can be delivered by peripheral venous catheterization （PVC） and central venous catheterization （CVC）.While PVC is the first choice for parenteral nutrition in most cases,CVC represents a better option in the case of high osmotic pressure （＞900 Osm/L） or prolonged nutritional support （＞ 14 days）.Percutaneous central venous catheterization through subclavian vein is advisable for critical patients,but its indwelling time should be kept under 30 days.Peripherally inserted central catheterization,with low risk of lesion and infectious complications,is recommended by Chinese guidelines for elderly patients.Implanted port provides reliable rout for patients who need long-term intravenous treatment,including parenteral nutrition.Patients with such device enjoy more freedom in daily life and better quality of life.When choosing intravenous infusion route,we need to take into consideration the patient＇s condition,desire and treatment time.Standardized application of catheterization is key to the safety of its use.