A TEENAGER with a rare condition that causes her to throw up 30 times a day says medics are running out of options to administer the daily mineral infusions that help to keep her alive.

Caitlin White has spent eight to nine hours a day as an outpatient at Perth Royal Infirmary for the past three and a half years having potassium and other minerals pumped directly into her bloodstream because she cannot get the nutrients she needs from food.

Read more: Fears Perth teen with rare vomiting disorder will 'starve to death'

However, the 19-year-old suffered a bout of sepsis in November which forced doctors to remove the central venous catheter (CVC) that had been surgically implanted into her chest.

CVC lines are typically left in for long-periods of time, but the risk of another potentially deadly infection means medics are relying on thinner cannula tubes instead which are left in for 48 hours at most.

In recent weeks, however, they have been struggling to insert them as years of failed attempts at artificial feeding have ravaged the teenager's veins.

Miss White said: "PRI consultants are very concerned, because if I was to take unwell and they need to get immediate access, and my veins are problematic now.

"The protocol at the moment for access is for the anaesthetist to be on standby to come to the aid of the doctors and nurses. The consultant anaesthetist spoke to me this morning, and managed to get a cannula in my foot.

"He said we are getting very close to the time when I possibly will need a central line in my neck. I’ve been told that the team of doctors at PRI have growing concern that what they are doing isn’t safe anymore."

Read more: NHS Tayside told to refer 'starving' teen to NHS Glasgow expert

The teenager, who is 5ft 5 but weighs less than six stone, has been told that her only option will be an inpatient admission to Ward 2 at Ninewells hospital in Dundee, where she could be monitored round-the-clock.

However, she is reluctant to return to the unit in Ninewells as she says the relationship between herself and the gastroenterology team was left "irretrievably broken down" following a lengthy previous stay which she says was mired in false accusations from staff that she was "making up" her symptoms.

The Herald: Caitlin WhiteCaitlin White

She has been seen by a number of private consultants and NHS gastroenterologists outside of Tayside who have described her case as one of the worst they have seen.

Miss White, who turns 20 in January, survives on soup, gels and powders but struggles to absorb sufficient calories and suffers excruciating abdominal pain as a result of gastroparesis, a condition which means her stomach is partially paralysed.

It has led her to develop cyclical vomiting syndrome, meaning she is often sick more than 30 times a day.

Read more: Perth teen in Catch-22 as medic warns artificial feeding 'could kill her' - but without it she faces potential organ failure

Her ordeal began aged 15 when stomach pain and vomiting saw her weight drop from 10 to eight stone in just three months and she was eventually admitted to Ward 2 at Ninewells in August 2014. She had 12 feeding tubes surgically inserted over 10 months.

However, her constant vomiting and a separate condition which makes Miss White's muscles abnormally slack meant the tubes came loose - sometimes within hours of surgery.

She also underwent Total Parenteral Nutrition (TPN), where protein, glucose and other nutrients are injected directly into a patient's bloodstream, but this was axed when she developed septicaemia in March 2015.

At that point she says doctors "gave up" and discharged her with no long-term plan for her care.

The Herald previously reported how Scotland's chief medical officer, Dr Catherine Calderwood, intervened in Miss White's case in April and insisted that the teenager be referred for a consultation to an expert outside of NHS Tayside due to her "exceptional circumstances".

Miss White's case was reviewed by Dr Ruth McKee, one of Scotland's gastro experts and a colorectal surgeon in NHS Greater Glasgow and Clyde. However, Dr McKee said she could only offer a second opinion and was unable to take on Miss White as a patient.

She also advised the teenager that artificial feeding could kill her due to the high risk of infection, but that without it she was also at risk of organ failure.

Miss White said she does not want to return to Ward 2 at Ninewells following her previous experience, but would consider treatment in another ward or preferably an out-of-area referral. NHS Tayside say this is not an option.

Miss White said: "It feels like a form of blackmail: 'come to ward 2 or you choose to suffer the consequences', basically.

"I've never refused treatment, I want to be clear about that. If they were prepared to do it on a different ward then I would take them up on it.

"I hoped maybe Catherine Calderwood could intervene again, because she managed to get it progressed last time.

"We're at a bit of a standstill and I'm in a very dangerous position because there were two days last week when we weren't able to get access and they had to leave it until the next day.

"If they hadn't been able to get access we'd be in a very dangerous situation because without replacing these levels it could go very wrong, very quickly."

A spokeswoman for NHS Tayside said: “Due to patient confidentiality we cannot comment on individual patients.

"The multidisciplinary expertise required for complex nutritional and gastroenterology issues is delivered on the specialist gastroenterology ward at Ninewells Hospital and does not exist elsewhere in NHS Tayside.

"NHS Tayside is committed to delivering effective, safe healthcare to patients in an appropriate environment with the necessary expertise from staff.

"For patients requiring specialist long term gastroenterology and nutritional care, this is delivered on one site by a small number of specialist staff."