Which of the following is NOT an approved VAD for HPN administration?

• A. Tunneled central venous catheter
• B. Implanted port
• C. Midline catheter
• D. Peripherally inserted central catheter

Answer: (C)

Central venous access is required for home parenteral nutrition because these solutions are hypertonic and can irritate peripheral veins or cause lipid-related complications if infused peripherally. A midline catheter sits in a peripheral vein and does not reach central circulation, so it cannot safely deliver long-term, lipid-containing PN. Tunneled central venous catheters and implanted ports are designed for long-term central access, and a peripherally inserted central catheter also reaches the central veins. Therefore, the midline catheter is not approved for HPN administration.