The next step is to consider the length of time anticipated for the TPN. Together with the amount of and tolerance for enteral feeds this will influence the decision to use peripheral (P-TPN) or central TPN. As the name implies, P-TPN is administered via a peripheral IV. Therefore a CVC/PICC line is not required, although sometimes it is given via a PICC whose tip is in a peripheral location. P-TPN is limited by the acceptable tonicity that can be given through a peripheral vein. Therefore, you are usually unable to provide maintenance calories without also giving excessive fluids. There is a high risk for phlebitis when giving P-TPN, as well as the risk of extravasation injury. The latter is usually due to extravasated calcium or potassium and can be severe enough to require later skin grafting. However, P-TPN is often successfully used as a supplement to enteral feeds or as a short-term measure until a CVC/PICC can be placed and central TPN instituted. Central TPN requires a CVC or a centrally placed PICC, together with their associated complications. However it does allow for the use of solutions with osmolalities greater than 900 mOsm/L. This in turn allows the delivery of adequate calories and nutrients for both maintenance and growth and development. It can also be used to provide long-term (in some cases years) nutritional support as an outpatient.