Arteriovenous Fistulae as an Alternative to Central Venous Catheters for Delivery of Long-Term Home Parenteral Nutrition

Outcome on home parenteral nutrition for benign intestinal failure: A review of the literature and benchmarking with the European prospective survey of ESPEN

“…Reduced infection risk has also been reported when HPN is infused via an arterovenous fistula instead of a CVC. 127 Published series (Tables 5 and 6) show that the death rate from CVC-related sepsis was higher in children (up to 30% of total death in patients with SBS or CIPO) than in adults (8% of total death in mixed population). However, the CVC-infection-related risk of death is reassuringly low.…”

Managing adult patients who need home parenteral nutrition

“…4 Home parenteral nutrition populations differ widely with respect to cancer as the primary disease: in contrast to Mediterranean countries and the United States, in the United Kingdom and Netherlands this group rarely receives home parenteral nutrition (table 1⇓). 5 6 Incurable cancer is not an absolute contraindication to receiving home parenteral nutrition but recent guidelines do not recommend it for patients with a short life expectancy, low performance score, or metastases to vital organs. 3…”

“…This result suggests that arteriovenous fistulas (fig 5⇓)are a feasible alternative to delivering home parenteral nutrition 6. …”

Review article: the management of long‐term parenteral nutrition

“…Some practitioners advocate the use of arteriovenous fistulae to administer long-term PN, with recent experience suggesting very low infection, but high occlusion rates. 36 When standard neck central venous access approaches have failed due to venous thrombosis and/or stenosis, the femoral approach can be considered although the risk of bacterial contamination is high. 37 Beyond this, translumbar, transhepatic and transcardiac catheter placements have been described.…”