Central Venous Access in the Home Parenteral Nutrition Population–You PICC

Abstract

The use of PICC for HPN may be associated with an increase in CRI. A prospective, randomized trial in the HPN population between PICC and OCVAD must be performed.

The prevalence of infections and patient risk factors in home health care: A systematic review

“…23 Various definitions were used to calculate infection rates. Researchers who focused on device-associated infections often reported infection rates as the number of infections per 1,000 device days 12-14,16,21,25,26,28-32,35,38 ; with some exceptions such as the number of infections per catheter year, 15,24,33 the number of infections per 100 catheter insertions, 37 the number of infections per 1,000 HPN days, 30 and the number of infections during the 31-month study period. 34 Researchers who studied various types of infections (eg, sepsis, urinary tract infection, respiratory infections, and skin infections) usually reported the proportion of infected patients out of the total number of patients.…”

“…Eight studies 12,16,23,24,28,30,32,35 identified the risk factors for IV catheter-associated infections as patient characteristics or medical history, including younger age (reported by 2 studies), 35,40 underlying diseases, 16,30 bone marrow transplant history, 32 receiving total parenteral nutrition treatment, 32 and history of bloodstream infection 32 ; treatment-related factors, including receiving infusion therapy outside the home, 32 in HPN treatment <5 years, 12 or family members with HPN training 12 ; catheter-related factors, including multilumen catheter 32 or central venous access salvage 23 ; and patient social or economic factors such as being a part-time student or recipient of social welfare. 12 Although most researchers found that catheter types were associated with infection, these findings were not consistent and sometimes even conflicted.…”

“…16 In addition, researchers also identified a peripherally inserted central catheter as a risk factor. 28 …”

Clinical outcome of long-term home parenteral nutrition in non-oncological patients: a report from two specialised centres

“…Three (7.4%) patients were referred to our Nutrition Center with an already implanted non-tunnelled CVC, which was replaced with a tunnelled one as soon as possible. Peripheral inserted CVC (PICC) were never used, as these are not indicated for long-term parenteral nutrition due to the high obstruction risk [39][40][41].…”

Iatrogenic Chylothorax Due to Pleural Cavity Extravasation of Total Parenteral Nutrition in Two Adults Receiving Nutrition through a Peripherally Inserted Central Catheter

“…Peripherally inserted central catheter use has become more popular in recent years, especially to deliver total parenteral nutrition (TPN), as their overall complication rates are approximately equivalent to those of other central access devices. [11][12][13][14][15] We report 2 cases of PICC-associated central extravasation of TPN related to repositioning and subsequent migration of the PICC. In both instances, signifi cant morbidity (including transfer to the intensive care unit [ICU]) occurred and effusions were initially diagnosed as chylothorax by radiologic evidence.…”