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Pulmonary Embolism as a Complication of Long‐Term Total Parenteral Nutrition
Author(s) -
Mailloux Richard J.,
Delegge Mark H.,
Kirby Donald F.
Publication year - 1993
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607193017006578
Subject(s) - medicine , parenteral nutrition , pulmonary embolism , thrombosis , complication , catheter , heparin , deep vein , intensive care medicine , surgery , venous thrombosis
Although much has been written concerning the complications of long‐term total parenteral nutrition, little or no mention of pulmonary embolism is made in the literature. We present two patients maintained on home total parenteral nutrition who suffered pulmonary emboli, one while receiving standard heparin therapy. No potential source other than their indwelling total parenteral nutrition catheter was identified. Studies have revealed catheter‐related thrombosis in up to 50% of patients with indwelling central venous catheters. Although early surgical literature suggested that upper extremity deep vein thromboses rarely embolize, more recent investigations have proven this false. In fact, the risk of pulmonary emboli appeared to be greatest in those thrombi that were catheter related. Because of this risk, we suggest a hypercoaguable work‐up in any patient with a history of recurrent thrombosis. Heparin is central to the current preventive regimens; however, further study is needed to determine the most efficacious dose. Future development of less thrombogenic catheters will also be of assistance. Thrombolytic agents currently have an expanding role in the treatment of thrombotic complications. Whether they will have a future role in prevention remains unknown. ( Journal of Parenteral and Enteral Nutrition 17: 578–582, 1993)