Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days

Bozzetti, Federico; Mariani, Luigi; Bertinet, D. Boggio; Chiavenna, G.; Crose, Nadia; Cicco, Marcello De; Gigli, Gian Luigi; Micklewright, A.; Villares, J.M. Moreno; Orban, A.; Pertkiewicz, M.; Pironi, Loris; Vilas, Mercè Planas; Prins, F.; Thul, P.

doi:10.1054/clnu.2002.0578

Cited by 113 publications

(104 citation statements)

References 34 publications

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“…In some cases, if a central venous catheter is available for other purposes (e.g., plasma exchange and/or Ig-IV cycles), parenteral nutrition also might be considered to provide nutritional support but major complications associated with its use and the need for proper care of this route should be always kept in balance [4,15].…”

Section: Discussionmentioning

confidence: 99%

Refractory myasthenia gravis, dysphagia and malnutrition: A case report to suggest disease-specific nutritional issues

Cereda

Beltramolli²,

Pedrolli³

et al. 2009

Nutrition

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Objective: We describe a case of refractory myasthenia gravis with bulbar involvement and the nutritional treatment solutions proposed to treat the associated dysphagia and malnutrition. Methods: A 39-y-old woman with refractory myasthenia gravis was referred to our clinical nutrition unit for deteriorating dysphagia and progressive malnutrition.Results: The first-line nutritional approach consisted of dietary counseling and thickened meals. Unfortunately, no adequate oral intake was achieved and an enteral nutrition treatment was proposed. A nasogastric tube was removed after a few days due to local pain and poor quality of life. Despite consistent weight loss and overt malnutrition, the patient refused percutaneous endoscopic gastrostomy placement. Neurologic symptoms did not show any improvement but unexpectedly the patient's weight started to increase to previous values. Anamnestic recall revealed that the patient learned by herself how to position the nasogastric tube that is now temporarily used for formula infusion coinciding with neurologic poussés. Conclusions: Current guidelines consider chronic neurologic diseases with associated dysphagia, where refractory myesthania gravis has also been considered, a unique category. Chronic neurogenic dysphagia with high risk of aspiration, long-term inability to obtain adequate oral intakes, and malnutrition are established indications for percutaneous endoscopic gastrostomy placement. However, patients may need different forms of nutritional intervention during the course of their illness and choices and indications should contemplate ethical reasons, clinical benefits, minimal risks, and acceptable quality of life. Minimally invasive intermittent enteral nutrition might be considered a possible clue for nutritional management of exacerbating dysphagia. Ó

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Section: Discussionmentioning

confidence: 99%

Refractory myasthenia gravis, dysphagia and malnutrition: A case report to suggest disease-specific nutritional issues

Cereda

Beltramolli²,

Pedrolli³

et al. 2009

Nutrition

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“…45,[52][53][54] The patient is key to minimising CVC-related sepsis rates at home. While patients accessing their line more frequently during the week may be at higher risk than those who receive PN less frequently, 55 with approximately 20% of patients on HPN are responsible for around 75% of the total number of CVC-related sepsis episodes. 47 It remains to be seen if this increased risk is in part linked to the bacterial skin and/or nasal ecosystem and/or to patient behaviour.…”

Section: Complications Of Long-term Pnmentioning

confidence: 99%

“…55,63 Patients with diagnosed venous thrombosis may be considered for thrombolytic therapy or thrombectomy if diagnosed early and all patients should be screened for thrombophilic risk and receive anticoagulation therapy (low molecular weight heparin or warfarin depending on the patient's intestinal absorptive ability). 40 If venous thrombosis is associated with CVC sepsis, then the line will likely have to be removed; otherwise, the decision to remove the catheter depends on patency: if intravenous infusion is impossible or induces pain or swelling, then the nonfunctioning catheter has to be removed, but if flow is unimpeded, the catheter can be maintained as CVC lifespan will not necessarily be impaired if the patient is anticoagulated.…”

Section: Catheter Occlusionmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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“…The most frequent HPN complications are infections (10,11). The infection rate is highly variable and depends on the patient's clinical conditions and the antiseptic techniques used by the administrators.…”

Section: Discussionmentioning

confidence: 99%

Home Parenteral Nutrition Therapy in Seven Patients with Anorexia Nervosa: The Role and Indications

Hotta

Araki

Urano³

et al. 2014

Intern. Med.

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Home parenteral nutrition (HPN) is a well-established intervention to sustain life in malnourished patients at home. Because it is difficult for patients with anorexia nervosa (AN) to gain weight or stop purging, such patients require repeated hospitalizations. Although HPN has not been commonly used for AN patients in Japan, we utilized this approach to treat seven AN patients. We herein present the clinical course and outcome of these seven patients, the application criteria for HPN in our institution, and the potential problems associated with HPN. Despite its complications, HPN may be a useful measure to help patients with persistent AN avoid multiple hospitalizations.

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Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days

Cited by 113 publications

References 34 publications

Refractory myasthenia gravis, dysphagia and malnutrition: A case report to suggest disease-specific nutritional issues

Refractory myasthenia gravis, dysphagia and malnutrition: A case report to suggest disease-specific nutritional issues

Review article: the management of long‐term parenteral nutrition

Home Parenteral Nutrition Therapy in Seven Patients with Anorexia Nervosa: The Role and Indications

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