Rate of Catheter‐Related Bloodstream Infections Between Tunneled Central Venous Catheters Versus Peripherally Inserted Central Catheters in Adult Home Parenteral Nutrition: A Meta‐analysis

Hon, Kay; Bihari, Shailesh; Holt, Andrew; Bersten, Andrew D.; Kulkarni, Hemant

doi:10.1002/jpen.1421

Cited by 24 publications

(30 citation statements)

References 100 publications

(296 reference statements)

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“…A study comparing PICCs with other CVADs in long-term HPN found no difference in the CRBSI rate, a higher frequency of catheter removal because of venous-thrombosis and a shorter time between catheter insertion and the first complication in the PICC cohort [89]. A meta-analysis of comparative studies showed a lower rate of CRBSI in HPN patients using PICCs; however, no difference between PICC and tunneled CVADs was observed when the singlearm studies were analyzed [93].…”

Section: Grade Of Recommendation B E Strong Consensus (100% Agreement)mentioning

confidence: 99%

ESPEN guideline on home parenteral nutrition

et al. 2020

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This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion line and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.

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Section: Grade Of Recommendation B E Strong Consensus (100% Agreement)mentioning

confidence: 99%

ESPEN guideline on home parenteral nutrition

et al. 2020

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“…25 Moreover, meta-analyses showed a lower or equivalent rate of CRT with PICC use. 25,26 In the last decade, many technological innovations have significantly increased the safety of PICCs (ultrasoundguided venipuncture, new biomaterials, sutureless devices for securement, and dedicated vascular teams), whereas new strategies have successfully minimized the risk of infection (standardized bundles of evidence-based interventions, strict policies of hand washing, education of healthcare operators, use of appropriate skin antisepsis, and use of antimicrobial lock therapy). 4,6,[27][28][29][30][31] Nowadays, the incidence rate of PICC-related complications has changed: CRBSIs, CRT, and mechanical complications are lower than those reported in the last 20 years.…”

Section: Discussionmentioning

confidence: 99%

Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter‐Days

Cotogni

Mussa

Degiorgis

et al. 2020

J Parenter Enteral Nutr

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Background: Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7-year, prospective cohort study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). Methods: We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. Results: We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. Conclusion: PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.

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“…8,13,27 Previous studies have mainly focused on CRBSIs in pediatric patients with IF or adults receiving HPN. 17,[28][29][30][31][32] However, the prevalence, potential risk factors, and spectrum of isolated microorganisms in NIs have never been reported in hospitalized patients with IF.…”

Section: Discussionmentioning

confidence: 99%

“…tions of NIs, has been commonly reported in hospitalized pediatric patients with IF and in adults requiring longterm home PN (HPN). [12][13][14][15][16][17] However, the prevalence and associated risk factors for NIs in hospitalized adult IF patients have never been reported.…”

Section: Introductionmentioning

confidence: 99%

Prolonged Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in Adult Patients With Intestinal Failure

et al. 2020

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Background Intestinal failure (IF) and its management are associated with an increased likelihood of infectious complications. This study aimed to evaluate the prevalence and potential risk factors for nosocomial infections (NIs) in hospitalized adult patients with IF. Methods In total, 259 eligible patients with IF admitted to a single clinical nutrition center in a tertiary referral hospital from January 1, 2012, to January 1, 2019, were retrospectively identified. NIs were defined according to the 2008 Centers for Disease Control and Prevention criteria. Univariate and multivariate analyses were performed to identify independent risk factors for NIs. Results The mean age of the study population was 47.0 ± 17.7 years, and 158 (61.0%) were men. The mean body mass index was 16.2 ± 2.9 kg/m2, and 219 (84.6%) were diagnosed with malnutrition. The prevalence of NIs was 25.5% (113 NIs in 66 patients). The most common NIs were pneumonia (14.3%), bacteremia of unknown origin (13.5%), catheter‐related bloodstream infection (5.0%), lower respiratory tract infection (5.0%), surgical site infection (3.9%), and urinary tract infection (1.9%). Multivariate analysis revealed that decreased serum albumin level (odds ratio [OR], 0.884; 95% CI, 0.883–0.978, P < .05), presence of gallbladder stones or cholestasis (OR, 3.144; 95% CI, 1.044–9.464; P < .05), and prolonged parenteral nutrition (PN) use (OR, 1.072; 95% CI, 1.039–1.105; P < .001) were independent predictors for NIs. Conclusions NIs remain prevalent in hospitalized adult patients with IF. Prolonged PN use was one of the most significant predictors for NIs.

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Rate of Catheter‐Related Bloodstream Infections Between Tunneled Central Venous Catheters Versus Peripherally Inserted Central Catheters in Adult Home Parenteral Nutrition: A Meta‐analysis

Cited by 24 publications

References 100 publications

ESPEN guideline on home parenteral nutrition

ESPEN guideline on home parenteral nutrition

Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter‐Days

Prolonged Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in Adult Patients With Intestinal Failure

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