Infectious Complications in Home Parenteral Nutrition: A Systematic Review and Meta-Analysis Comparing Peripherally-Inserted Central Catheters with Other Central Catheters

Mateo-Lobo, Raquel; Riveiro, Javier; Vega-Piñero, Belén; Botella-Carretero, José I.

doi:10.3390/nu11092083

Cited by 14 publications

(14 citation statements)

References 37 publications

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“…While similar percentages were found in other studies, the rates were higher with 1.06–5.06 events per 1,000 catheter-days [21, 27, 29]. According to a recent meta-analysis of prospective trials, the current evidence is insufficient to show differences in infection rates between tunnelled catheters and peripherally inserted central catheters while the latter shows lower infection rates compared to port systems [30]. Furthermore, there were no differences in the rates of mechanical complications and catheter-related thrombosis.…”

Section: Discussion/conclusionmentioning

confidence: 50%

Management of Home Parenteral Nutrition: Complications and Survival

Reber¹,

Staub²,

Schönenberger³

et al. 2021

Ann Nutr Metab

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Background and Aims: Parenteral nutrition (PN) has become an efficient, safe, and convenient treatment over years for patients suffering from intestinal failure. Home PN (HPN) enables the patients to have a high quality of life in their own environment. The therapy management however implies many restrictions and potentially severe lethal complications. Prevention and therapy of the latter are therefore of utmost importance. This study aims to assess and characterize the situation of patients with HPN focusing on prevalence of catheter-related complications and mortality. Methods: Swiss multicentre prospective observational study collecting demographic, anthropometric, and catheter-related data by means of questionnaires every sixth month from 2017 to 2019 (24 months), focusing on survival and complications. Data were analysed using descriptive statistics. Logistic regression models were fitted to investigate association between infection and potential co-factors. Results: Seventy adult patients (50% women) on HPN were included (≈5 patients/million adult inhabitants/year). The most common underlying diseases were cancer (23%), bariatric surgery (11%), and Crohn’s disease (10%). The most prevalent indication was short bowel syndrome (30%). During the study period, 47% of the patients were weaned off PN; mortality rate reached 7% for a median treatment duration of 1.31 years. The rate of catheter-related infection was 0.66/1,000 catheter-days (0.28/catheter-year) while the rate of central venous thrombosis was 0.13/1,000 catheter-days (0.05/catheter-year). Conclusion: This prospective study gives a comprehensive overview of the adult Swiss HPN patient population. The collected data are prerequisite for evaluation, comparison, and improvement of recommendations to ensure best treatment quality and safety.

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Section: Discussion/conclusionmentioning

confidence: 50%

Management of Home Parenteral Nutrition: Complications and Survival

Reber¹,

Staub²,

Schönenberger³

et al. 2021

Ann Nutr Metab

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“…However, PICCs were usually inserted when the patient was not able to care for the VAD or when affected by an acute condition. Conversely, 1 prospective study and a meta‐analysis showed that patients using ports for HPN had a significant increase in CRBSIs compared with PICCs, whereas no difference between PICCs and tunneled‐cuffed catheters was found 38,39 …”

Section: Discussionmentioning

confidence: 99%

“…Conversely, 1 prospective study and a meta-analysis showed that patients using ports for HPN had a significant increase in CRBSIs compared with PICCs, whereas no difference between PICCs and tunneled-cuffed catheters was found. 38,39 Nowadays, whether the PICC is an appropriate VAD for long-term treatment is still a controversial issue. The ASPEN guidelines have stated that the maximum dwell time of PICCs is unknown and that they are suitable for mediumterm PN.…”

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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“…It has been reported that it is easy to cause catheter blockage, infection, mechanical phlebitis and other adverse complications due to improper care, of which the most serious one is catheter-related bloodstream infection (CRBSI) [5]. Previous studies [6,7] have reported that the incidence of CRBSI in NICU varied from 7.25 to 13.78%. CRBSI not only prolongs the hospitalization time of newborns, but also may increase the mortality of newborns [8].…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors of PICC-related bloodstream infection in newborns: implications for nursing care

Ling

et al. 2021

Eur J Med Res

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Background It is necessary to analyze the characteristics and risk factors of catheter-related bloodstream infection (CRBSI) in newborns with peripherally inserted central catheter (PICC). Methods Newborns undergoing PICC catheterization in the neonatal department of our hospital from January 1, 2020 to January 31, 2021 were included. The characteristics of newborns with and without CRBSI newborns were compared and analyzed. Logistic regression analyses were performed to evaluate the risk factors of CRBSI in newborns with PICC. Results Three hundred eighty-six newborns with PICC were included, of whom 41 newborns had the CRBSI, the incidence of CRBSI in newborns with PICC was 10.62%. There were significant differences regarding the birth weight, durations of PICC stay, 5-min Apgar score, site of PICC insertion of PICC between CRBSI and no CRBSI group (all P < 0.05), and there were no significant differences regarding the gender, gestational age, cesarean section, mechanical ventilation and length of hospital stay between CRBSI and no CRBSI group (all P > 0.05). Escherichia coli (26.08%) and Staphylococcus aureus (23.92%) were the most common CRBSI pathogens in newborns with PICC. Logistic regression analysis indicated that birth weight ≤ 1500 g (OR 1.923, 95% CI 1.135–2.629), durations of PICC stay ≥ 21 days (OR 2.077, 95% CI 1.024–3.431), 5-min Apgar score ≤ 7 (OR 2.198, 95% CI 1.135–3.414) and femoral vein insertion of PICC (OR 3.044, 95% CI 1.989–4.306) were the independent risk factors of CRBSI in neonates with PICC (all P < 0.05). Conclusion For newborns with low birth weight, longer durations of PICC stay and femoral vein PICC insertion, they may have higher risks of CRBSI, and medical staff should take targeted measures to reduce the development of CRBSI.

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Infectious Complications in Home Parenteral Nutrition: A Systematic Review and Meta-Analysis Comparing Peripherally-Inserted Central Catheters with Other Central Catheters

Cited by 14 publications

References 37 publications

Management of Home Parenteral Nutrition: Complications and Survival

Management of Home Parenteral Nutrition: Complications and Survival

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

Analysis of risk factors of PICC-related bloodstream infection in newborns: implications for nursing care

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