The reality is that there are a finite number of sites, and when someone is on TPN long term, they could run out. All efforts should be made to preserve venous access and extend the life of each catheter or port. Limited progress has been made in the ongoing research of catheter materials in trying to preserve venous access for longer periods of time or to reduce complications. He said that University of California Davis and Deaconess Hospital in Boston, MA, have begun the use of low-dose warfarin to maintain catheter potency. There are some concerns that the long term use of heparin may not be good for bones.
More research is needed before heparin can be uniformly eliminated from all TPN regimens.
Also discussed by Dr. Nishikawa was the fact that infections in the long term TPN consumer are the most common reason for hospitalizations. He touched on liver dysfunction as well. Liver dysfunction is not uncommon and often there are reversible causes which can be eliminated. This may reduce the risk or normalize liver enzymes. There remain selected cases where no causative factor can be found.