Do lipids need to be administered through a central line or a peripheral line?

From the Guidelines

Lipids can be administered through both central and peripheral lines, but the choice depends on the concentration of the lipid emulsion and the patient's specific needs. The most recent and highest quality study, published in 2024 1, provides guidance on the administration of lipid emulsions. According to this study, standard lipid emulsions (10-20%) can be safely administered through peripheral lines due to their isotonicity and lower risk of vein irritation. This makes them suitable for short-term parenteral nutrition in patients with limited central access. However, when lipids are part of total parenteral nutrition (TPN) solutions that contain high concentrations of dextrose and amino acids, a central line is preferred due to the high osmolarity of the complete mixture. Central administration is also recommended for long-term lipid therapy or when higher concentrations are needed. Some key points to consider when administering lipids peripherally include:

• Using a dedicated line or the distal port of a multiple lumen catheter to prevent incompatibility with other medications
• Monitoring serum triglyceride levels to ensure they are within local or regional guidelines
• Considering the use of mixed lipid emulsions containing soybean oil, olive oil, MCTs, and/or fish oil, which have not been shown to lead to essential fatty acid deficiency in clinical practice 1
• Administering supplemental PN through a peripheral line can be considered over a short period of time when central line access is unavailable or as a bridge until central line access is available 1

From the Research

Administration of Lipids

• Lipids can be administered through a peripheral line, as studies have shown that peripheral parenteral nutrition (PPN) with simultaneous infusion of lipid emulsion is no more phlebogenic than usual maintenance solutions during the first 72 hours 2.
• The incidence of phlebitis is similar in groups receiving PPN with lipid emulsion and those receiving maintenance solutions, suggesting that lipids can be safely administered through a peripheral line 2.
• Simultaneous infusion of lipid emulsion with an amino acid-dextrose-electrolyte solution can reduce the incidence of thrombophlebitis during postoperative peripheral parenteral nutrition 3.

Central Line vs Peripheral Line

• There is no clear evidence to suggest that lipids must be administered through a central line, as peripheral lines can be used safely and effectively 2, 3.
• The use of peripheral intravenous catheters for lipid administration is common, and the incidence of phlebitis can be managed with appropriate interventions 4.
• The choice between central and peripheral lines for lipid administration may depend on individual patient factors and clinical judgment, rather than a strict requirement for central line use.

Risk Factors for Phlebitis

• The incidence of phlebitis is higher in non-intervened groups and with certain types of catheter use, such as Teflon catheters 4.
• Female gender, longer dwelling time, antibiotics infusion, forearm insertion, infectious disease, and Teflon catheter use are identified as risk factors for phlebitis development 4.
• The use of lipid emulsion may have a preventive effect against thrombophlebitis during postoperative peripheral parenteral nutrition, suggesting a potential benefit for lipid administration through a peripheral line 3.