Damage of Central Catheters in Home Parenteral Nutrition Patients

Błasiak, Renata; Ławiński, Michał; Majewska, K.; Gradowska, Aleksandra

doi:10.1515/pjs-2016-0006

Cited by 9 publications

(19 citation statements)

References 13 publications

(6 reference statements)

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“…In fact, Blasiak et al reported that they routinely obtain blood cultures prior to all CVC repairs. If the CVC was damaged >24 hours prior to repair, they hold off on the repair until cultures return as negative . Other groups including ours, however, did not report such a practice, and the reported rates of CLABSI before and after repair have been quite variable.…”

Section: Discussionmentioning

confidence: 78%

“…Loss of the integrity of the external part of the catheter can pose an increased risk of CLABSI; therefore, close inspection and examination of the catheter by the HPN team is recommended by ASPEN . In cases of confirmed catheter rupture, replacement is recommended, and in all other cases in the absence of infection, catheter repair can be performed . Our single‐center retrospective review of 36 patients receiving long‐term HPN who underwent 55 catheter repairs revealed that catheter repair was effective in prolonging life of CVC, with median duration of 685 days (136–1037 days) post‐repair.…”

Section: Discussionmentioning

confidence: 99%

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Repair of Central Venous Catheter in a Single‐Center Adult Home Parenteral Nutrition Cohort

Velapati

Schroeder

Kuchkuntla

et al. 2019

J Parenter Enteral Nutr

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Background Patients with chronic intestinal failure who require long‐term parenteral nutrition rely on central venous catheters (CVCs) for access to nutrition and hydration. With prolonged use, complications such as central line–associated bloodstream infection (CLABSI), damage to CVC, and central venous thrombosis (CVT) can threaten the availability of life‐preserving access. Because of this, all efforts should be made to preserve CVCs with techniques such as catheter salvage in case of CLABSI and catheter repair when damaged. The present study was conducted to evaluate the effectiveness and safety of catheter repair in our patient population. Methods Retrospective review in 1253 adult patients who received home parenteral nutrition at the Mayo Clinic between September 1, 1997, and April 30, 2018, was conducted to determine the incidence of CLABSI and CVT in patients who underwent CVC repair. Results Fifty‐five CVC repairs were performed in 36 patients (n = 23 female) with mean age of 57.05 ± 16.96 years. A total of 14 catheters (25.45%) were complicated with 24 episodes of CLABSI. CLABSI rate before and after repair was 0.23/1000 catheter days and 0.21/1000 catheter days, respectively. Most common indications for eventual catheter replacement were mechanical damage (32%), infection (32%), and switching to alternate mode of nutrition (24%). We had a 100% success rate of catheter repair procedure, and no post‐procedural complications were present. Conclusion Catheter repair can increase the catheter survival without increasing the risk of CLABSI, providing not only socioeconomic benefit but also decreasing risk of compromising future vascular access.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Repair of Central Venous Catheter in a Single‐Center Adult Home Parenteral Nutrition Cohort

Velapati

Schroeder

Kuchkuntla

et al. 2019

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…Catheter fracture typically occurs above the catheter hub where the catheter clip is located. Catheter fracture can be associated with flushing attempts to clear an occluded catheter 82 . High pressures in the lumen of the catheter lead to internal wall rupture and the catheter expanding in a balloon‐like fashion.…”

Section: Catheter Rupture/fracturementioning

confidence: 99%

“…Most commonly in HPN, catheter occlusion occurs as a result of fat/protein deposits, particularly if the catheter is not flushed promptly following PN administration. Catheter occlusion is said to represent 25%–40% of all catheter‐related problems, although this may represent an underreported figure 82 . Fibrin deposits can form around the catheter lumen and can prevent aspiration of blood without interfering with infusion and flushing.…”

Section: Catheter Occlusionmentioning

confidence: 99%

Home Parenteral Nutrition: Vascular Access and Related Complications

Dibb

Lal

2017

Nut in Clin Prac

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Patients with chronic intestinal failure are dependent on parenteral nutrition (PN) to maintain health and preserve life. Maintaining safe vascular access is vital to prevent life-threatening complications such as catheter-related bloodstream infection or central venous occlusion. Dedicated central venous catheters with rigorous catheter care aseptic protocols are vital in obtaining good long-term outcomes that allow continuation of PN over many years. Good catheter care requires an experienced multidisciplinary team using appropriate vascular devices, trained to identify and aggressively treat catheter-related bloodstream infections, catheter occlusions, and catheter-related thrombosis. Consideration must also be given to evolving strategies to prevent recurrent infections, including prophylactic central venous catheter locks.

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“…Small and Gabe had a 92% (46 of 50) success rate in CVC repairs done from January 2010 to December 2011 . In a review of 99 HPN patients with mechanical catheter complications, Blasiak et al demonstrated successful CVC repair in 48% of catheter complications vs catheter replacement in the other 52% . In a study of 13 pediatric IF patients, McNiven reported 8 CVC repairs, which importantly increased the longevity of the CVC to 341.7 days vs 114.4 days in the replacement group ( P ‐value = 0.002) .…”

Section: Success Rate Of Cvc Repairmentioning

confidence: 99%

Repair of Central Venous Catheters in Home Parenteral Nutrition Patients

et al. 2019

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For patients receiving home parenteral nutrition (HPN), vascular access with a central venous catheter (CVC) is essential to safely administer parenteral nutrition (PN) to meet their nutrition and hydration needs. Unfortunately, despite rigorous training and prevention strategies, CVCs are susceptible to complications such as infection, occlusion, thrombosis, and mechanical failure. Much of the published research on CVC complications focuses on infections; however, catheter occlusions and mechanical failures also contribute significantly to catheter dysfunction and loss. Frequent CVC exchanges put HPN patients at risk of loss of vascular access, making it essential that any strategies that can salvage the CVC be implemented prior to removal. CVC repair is 1 technique that can be utilized to avoid CVC exchanges in certain situations. CVC repairs can be performed in the office or on the ward and are cost effective when compared with CVC replacement. When performed by trained clinical staff, the procedures are highly successful and associated with low risk.

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Damage of Central Catheters in Home Parenteral Nutrition Patients

Cited by 9 publications

References 13 publications

Repair of Central Venous Catheter in a Single‐Center Adult Home Parenteral Nutrition Cohort

Repair of Central Venous Catheter in a Single‐Center Adult Home Parenteral Nutrition Cohort

Home Parenteral Nutrition: Vascular Access and Related Complications

Repair of Central Venous Catheters in Home Parenteral Nutrition Patients

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