Although the use of parenteral nutrition was one of the milestone breakthroughs in the care of critically ill patients, serious morbidities are associated with its use. One troublesome complication is total parenteral nutrition (TPN) catheter-related sepsis, which is associated with poorer outcomes in patients, including longer intensive care unit (ICU) stays, longer hospital stays, and higher mortality. To this end, some hospitals have developed entire care teams dedicated to the management of central venous lines used for TPN, including insertion procedure, skin site inspection, dressing changes, and evaluation of possible infection. Given the potential morbidities, numerous studies have been done to determine the best protocols for catheter care used for TPN.

From an accumulating body of research regarding how to reduce risks of infection, including TPN catheter tip infection, site infection, bacteremia, and catheter colonization, the following facts seems clear: (a) TPN should be initiated through a new catheter inserted via a clean stick, not a catheter changed over a wire; (b) TPN catheters should be inserted via subclavian (preferably) or internal jugular veins, not via femoral veins; (c) TPN should have its own dedicated lumen used for nothing else; and (d) a team dedicated to TPN central-line care should be assembled to lower catheter infection rates. A 2003 study by Dimick et al. showed that single-lumen subclavian catheters dedicated to TPN use and cared for by a dedicated team had a fivefold decrease in infection compared with other catheters that were used for multiple reasons. One final note is that because the realities of care in seriously ill patients do not always allow for the placement of a dedicated TPN line, one port of a newly placed multiple-lumen catheter can be designated for exclusive administration of TPN if no other options exist.