List the three types of vascular access devices (VADs) approved for home parenteral nutrition (HPN) administration.

• A. Tunneled central venous catheters; Implanted ports; Peripherally inserted central catheters
• B. Tunneled catheters; Subcutaneous ports; Internal jugular catheters
• C. Peripheral IV lines; Implanted ports; Midline
• D. Central venous catheters; Dedicated port; Peripheral IVs

Answer: (A)

Access for home parenteral nutrition must be a durable, central pathway that can handle long-term, hyperosmolar infusions while minimizing infection risk. The three types commonly approved for HPN are tunneled central venous catheters, implanted venous ports, and peripherally inserted central catheters. Tunneled central venous catheters are surgically placed and exit the body after traveling under the skin, which lowers infection risk and makes them suitable for long-term use. Implanted ports sit beneath the skin with a separate reservoir that is accessed with a needle; they’re discreet and have low infection rates, making daily care easier for many patients. Peripherally inserted central catheters start in a peripheral vein, typically in the arm, and extend to the central veins; they provide central access with easier insertion and are appropriate for medium-term PN needs, though they do carry infection and thrombosis considerations and may not be as durable as tunneled lines.

These options together cover the main long-term central access choices used for home PN. Other devices like peripheral IVs or midlines aren’t suitable for the hyperosmolar PN solutions or the duration required for home therapy.