For a 10-day course of TPN, which venous access device is most appropriate?

• A. Percutaneous endoscopic gastrostomy
• B. Implanted port below the clavicle
• C. Peripheral IV in the antecubital fossa
• D. Multi-lumen subclavian catheter

Answer: (D)

Central venous access is essential for total parenteral nutrition because the solutions are highly concentrated and can irritate peripheral veins, so reliable, high-flow access with multiple lumens is needed to run TPN and lipid emulsions safely. A multi-lumen subclavian catheter provides sturdy central venous access that can support continuous TPN and separate lipid infusions, making it the most practical choice for a 10-day course. A percutaneous gastrostomy is for enteral feeding, not venous access, so it cannot deliver TPN. An implanted port below the clavicle could be used for central access, but for a short 10-day course it’s less convenient and typically reserved for longer-term intermittent use. A peripheral IV in the antecubital fossa isn’t appropriate for TPN due to higher risk of phlebitis and limited duration and osmolarity tolerance.