An older adult patient requires parenteral nutrition for 6 weeks but has no IV access. Which vascular access device is most appropriate?

• A. Port
• B. PICC
• C. Peripheral access
• D. Short-term central venous catheter

Answer: (B)

For parenteral nutrition lasting several weeks, the key is reliable central access that can be established quickly and maintained safely without a surgical procedure. PN is administered through a central line because the solutions are highly osmolal and caustic to peripheral veins, so peripheral IVs aren’t suitable. A peripherally inserted central catheter (PICC) fits well here: it can be placed at the bedside with ultrasound guidance, provides central venous access with the catheter tip in a central vein, and is designed for dwell times spanning weeks to months, which matches a six-week course. It offers stable, continuous access for PN and routine labs while minimizing the need for an invasive procedure or a temporary short-term catheter that would be less ideal for several weeks. An implanted port could work for long-term use but requires a surgical implantation and a special access technique, which is less convenient for a six-week plan. A short-term central venous catheter is typically intended for shorter durations and carries higher risk if kept in place for weeks.