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November 28, 1977

Peripheral Blood Access for Hyperalimentation: Use of Expanding Polytetrafluoroethylene Arteriovenous Conduit

JAMA. 1977;238(22):2399-2400. doi:10.1001/jama.1977.03280230063026

TOTAL parenteral nutrition may be complicated in patients who have central venous lines and who require long-term therapy. Use of standard arteriovenous fistulas has generally been unsuccessful in the normally coagulable nonuremic patient. Arteriovenous shunts have been successful at times but have their drawbacks.11 An expanded polytetrafluoroethylene graft was used for repeated vascular access for hyperalimentation in a patient whose initial alimentary therapy was interrupted by recurrent infection of the central venous line used for caloric administration.

Report of a Case  A 36-year-old obese woman was admitted to the University of Minnesota Hospitals. She had several draining abdominal fistulas two months after a jejunoileal bypass had been performed. She had hepatic insufficiency, several abdominal fistulas, and diffuse signs of malnutrition. A central venous line was placed, and hyperalimentation was started in February 1977 using a combination of soybean oil, 25% dextrose in water and 4.25% amino acid, synthetic solution