Thromboembolism in Infants and Children With Gastrointestinal Failure Receiving Long‐Term Parenteral Nutrition

Kakzanov, Vered; Monagle, Paul; Chan, Anthony

doi:10.1177/014860710803200188

Cited by 33 publications

(30 citation statements)

References 52 publications

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“…This case series cannot establish an association between ethanol lock therapy and thrombosis in the HPN population because the background rate of CVC thrombosis in our particular population is unknown 17 . Other retrospective reports of ethanol lock therapy have not observed a statistically significant increase in CVC occlusion compared with historical control periods.…”

Section: Discussionmentioning

confidence: 69%

“…In light of the in vitro evidence suggesting that shorter dwell times (down to 2 hours) might be adequate for removal of bacterial biofilm, 10 a prospective study investigating shorter dwell times is warranted. In addition, it is likely that concurrent anticoagulant therapy (eg, warfarin therapy) may affect the risk of thrombosis with ethanol locks, although this is difficult to quantify and unproven 17 …”

Section: Discussionmentioning

confidence: 99%

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Central Venous Catheter Thrombosis Associated With 70% Ethanol Locks in Pediatric Intestinal Failure Patients on Home Parenteral Nutrition

Wong

Clifford

McCallum

et al. 2011

J Parenter Enteral Nutr

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Central venous catheter (CVC) ethanol locks may reduce catheter-related bloodstream infection (CRBSI). Four children with intestinal failure on home parenteral nutrition (HPN) were selected for 70% ethanol locks because of their high rate of CRBSI. The 70% ethanol locks were instilled at a volume equal to the estimated internal volume of the CVC. Two children (aged 4 and 11 years) received 70% ethanol locks as CRBSI prophylaxis; another 2 children (aged 10 and 11 years) received 70% ethanol locks as adjunctive treatment for CRBSI. All 4 children developed either visible thrombosis in the CVC or CVC occlusion. To the authors' knowledge, this is the first report of CVC thrombosis associated with ethanol lock therapy in the pediatric HPN population. Although none of the CVCs were removed due to occlusion, these events raise serious concerns about the use of high-concentration ethanol locks.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Central Venous Catheter Thrombosis Associated With 70% Ethanol Locks in Pediatric Intestinal Failure Patients on Home Parenteral Nutrition

Wong

Clifford

McCallum

et al. 2011

J Parenter Enteral Nutr

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“…In the Fontan procedure, with the RA connected to the pulmonary artery bypassing the right ventricle, the velocity of blood flow to the pulmonary circulation is decreased compared with that in a normal heart. Prematurity, malignancies, protein losing state (nephrotic syndrome, renal failure, and gut failure), and parenteral nutrition are known to be associated with hypercoagulable states and are additive risk factors for RAT in the presence of central venous catheters [7,42,43].…”

Section: Discussionmentioning

confidence: 99%

Neonatal and childhood right atrial thrombosis: recognition and a risk-stratified treatment approach

Yang

Williams

Brandão

et al. 2010

Blood Coagulation & Fibrinolysis

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Pediatric literature and guidelines of treatment options for right atrial thrombosis (RAT) are lacking; thus, this review summarizes the available literature on RAT in infants and children. Medline search identified 35 publications, with 27 prospective or retrospective case series included for data analysis. A total of 122 cases of RAT were identified. The mean age of patients is 3.58 years (n = 86) with a strong predominance in the neonatal and infancy period. Ninety-one percent of cases were found to be associated with central venous catheters, 40.8% are premature neonates, 27.2% are postcardiac surgery patients, and 19.2% have underlying malignancies. Gut failure with total parenteral nutrition given via the central venous catheters occurred in 45.6% of patients. The most frequent presenting symptoms are respiratory distress and arrhythmia, and 56.8% (42 of 74) were asymptomatic. Our study defined high-risk features on echocardiogram as large size, more than 2 cm in any dimension, pedunculated, mobile, or snake-shaped, and mobile. Our result confirmed there is significant difference in the mortality for the high-risk group (16.7%; three of 18) versus the low risk group (0%; n = 32; P = 0.0416). Moreover, none of the asymptomatic patients showed progression in disease or died. Asymptomatic and hemodynamically stable patients with RAT who are at low risk are associated with good prognosis irrespective of treatment. We recommended removal of central venous line if possible, with or without anticoagulation for this group of patients. Systemic anticoagulation therapy should be given to all high-risk or symptomatic RAT patients. Surgical thrombectomy or thrombolytic therapy carries significant risk and should be considered individually.

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“…GRADE: Weak (Tables 16 and 17) Rationale: Central venous access-related complications include infection, catheter occlusion, and thromboembolism. 156 Although including unfractionated heparin in PN admixtures may influence infection [157][158][159] and catheter occlusion, 160,161 these are multifactorial complications. A prospective trial of IV heparin infusion in patients with a central venous catheter was able to reduce (but not eliminate) the risk of thrombus formation compared with patients receiving no heparin prophylaxis.…”

Section: Questionmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

265

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Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

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Thromboembolism in Infants and Children With Gastrointestinal Failure Receiving Long‐Term Parenteral Nutrition

Cited by 33 publications

References 52 publications

Central Venous Catheter Thrombosis Associated With 70% Ethanol Locks in Pediatric Intestinal Failure Patients on Home Parenteral Nutrition

Central Venous Catheter Thrombosis Associated With 70% Ethanol Locks in Pediatric Intestinal Failure Patients on Home Parenteral Nutrition

Neonatal and childhood right atrial thrombosis: recognition and a risk-stratified treatment approach

A.S.P.E.N. Clinical Guidelines

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