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Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7–10 days) parenteral nutrition (PN) requires central venous access whereas for PN 3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7–10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site., GMS German Medical Science; 7:Doc19; ISSN 1612-3174

In a prospective study, 8-MHz unidirectional, continuous wave Doppler equipment was shown to improve the success rate of internal jugular vein catheterization. In the first series of 100 patients, punctures were randomly divided into two groups, via the anterior or posterior route, representing the standard technique. The second series of 50 patients underwent punctures guided by the Doppler technique. The Doppler route was successful in 48 test punctures with 47 catheter placements. Via the anterior route, 14 of 50 test punctures were positive, with 11 catheter placements; for the posterior route, test punctures were positive in 25 of 50 cases, with 18 catheter placements. With the Doppler technique, it should be possible to increase the rate of successful catheterization of the internal jugular vein while reducing complications.

Die Ultraschall-Doppler-Technik ist eine nichtinvasive, einfach erlernbare Methode zur Beurteilung der arteriellen und venosen Blutstromung. Sie kann in Anasthesie und Intensivmedizin in verschiedenen Bereichen nutzlich sein, so zur exakteren arteriellen Blutdruckmessung in schwierigen Fallen, bei Durchblutungsstorungen oder zur Unterstutzung der Punktion arterieller und venoser Gefase. Zur Objektivierung der Effekte der Periduralanasthesie auf den peripheren Widerstand, zur Ermittlung von Blutflusraten bei arteriovenoser Hamofiltration und als Screening-Methode fur den cerebralen Kreislaufstillstand ist die Doppler-Technik ebenfalls erfolgreich eingesetzt worden. The ultrasound Doppler technique is a non-invasive method for the evalution of arterial and venous blood flow. It can be useful in anaesthesia and in intensive medicine for different purposes, e.g. for more exact blood pressure determination in difficult cases, in cases of blood supply disorders or as a helpful guide for the puncture of arterial and venous vessels. This technique has also been used successfully as a screening method of cerebral death, for the evaluation of flow rates during arterio-venous hemofiltration and for the investigation of the effects of peridural anaesthesia on peripheral resistance.