Long-term home parenteral nutrition in children with chronic intestinal failure: A 15-year experience at a single Italian centre

Gandullia, Paolo; Lugani, Francesca; Costabello, Laura; Arrigo, Serena; Calvi, Angela; Castellano, E.; Vignola, Silvia; Pistorio, Angela; Barabino, A.

doi:10.1016/j.dld.2010.04.012

Cited by 61 publications

(70 citation statements)

References 33 publications

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“…Gandullia et al described an in-hospital, nurse-led, two-to three-week training programme for families focusing on signs of sepsis and mechanical problems. 20 There is no consensus in literature regarding the optimum duration for training required to prepare families for life on PN at home; however, training programmes of up to eight weeks in duration is in use in clinical practice across the United Kingdom (personal communication). European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines for PN at home for adult patients emphasised the content of the teaching programme to include catheter care, prevention, recognising and managing complication and storage and handling of the bags.…”

Section: Discussionmentioning

confidence: 99%

Aseptic non‐touch technique and catheter‐related bloodstream infection in children receiving parenteral nutrition at home

et al. 2015

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Objectives: Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers. Methods: We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013. Results: Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000 line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000 line-days. Conclusion: In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN.

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Section: Discussionmentioning

confidence: 99%

Aseptic non‐touch technique and catheter‐related bloodstream infection in children receiving parenteral nutrition at home

et al. 2015

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“…IF patients treatment conducted by specialized centres with sufficient experience has been rightfully declared an important condition of successful HPN program [2,3,4,5,7,12,19,21]. In the Czech Republic (population 10 million), the 66 reported patients were followed by 8 departments in the course of 16 years, with only 3 centres treating more than 10 children (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…HPN enables the survival, growth, development, and acceptable quality of life in infants and children with IF without the need of prolonged hospitalization [1,2,3,4,5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

Paediatric Home Parenteral Nutrition in the Czech Republic and Its Development: Multicentre Retrospective Study 1995-2011

Stýblová¹,

Kalousová

Adamcová³

et al. 2017

Ann Nutr Metab

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Background: Treatment quality and outcomes of paediatric home parenteral nutrition (HPN) program during its development in the Czech Republic. Methods: A retrospective study of patients receiving HPN from May 1995 till June 2011. Results: Sixty-six patients were treated in 8 centres. In 48 patients, long-term PN began in the first year of life and in 35 of them in the first month. Sixty children had gastrointestinal and 6 had non-gastrointestinal disease. In a majority of the patients, the Broviac catheter was used. Thirty-two (48.5%) patients were weaned from PN after 1-117 months, 21 (32.8%) continued on HPN after 7-183 months, and 13 (19.7%) patients died, all on PN. The mortality in patients with primary gastrointestinal disease was significantly lower than in patients with non-gastrointestinal disease. Thirty-one paediatric patients were receiving HPN for 14,480 catheter days in 2009-2010. Fourteen patients had 23 Catheter Related Blood Stream Infections (CRBSI) episodes. The incidence of CRBSI in 2009-2010 was 1.58/1,000 catheter days. Conclusion: Submitted data showed that even in the absence of expert centres, patient care may achieve results comparable to countries with well-developed HPN program. A majority of Czech HPN patients are at present treated in specialized centres, following the most desirable pattern of care.

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“…29,30 A impossibilidade de aspiração através de um cateter pelo qual é possível perfundir pode dever-se: à formação de um agregado de fibrina à volta do cateter; a um trombo na ponta do cateter (um trombo intraluminal ocasionará obstrução à infusão); ou a um cateter encostado a um vaso ou câmara cardíaca. 6,30 A obstrução por um agregado de fibrina ou trombo intraluminal pode ser ultrapassada com a instilação de doses baixas de agentes fibrinolíticos (p.e.…”

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“…17,29,[34][35][36][37][38][39][40][41] A taxa de infeção é mais alta em recém-nascidos e no caso de cateteres de múltiplo lúmen. A incidência de complicações infeciosas é substancialmente maior na NP, quer seja por PICC quer seja por CVC, com taxas até seis vezes superiores na síndroma de intestino curto devido à translocação bacteriana.…”

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Vias para Nutrição Artificial na Criança (II): Acessos Parentéricos

Estevão‐Costa

2014

Acta Med Port

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RESUMOA nutrição artificial por via parentérica é de crucial importância quando a utilização do trato gastrointestinal não é exequível. Neste artigo é revista a literatura relevante acerca das principais técnicas para acessos parentéricos na criança, suas indicações, princípios de colocação e manutenção, e complicações. A escolha do tipo de acesso venoso é baseada, sobretudo, na duração prevista para a nutrição parentérica e no peso/estatura corporal. O acesso periférico é viável e vantajoso para a nutrição parentérica de curta duração (< 2 semanas); um cateter venoso central tunelizado (Broviac) é geralmente necessário na nutrição parentérica de longa duração (> 3 semanas); a colocação periférica de um cateter central é uma alternativa de utilização crescente. Os acessos parentéricos são eficazes e seguros, embora com morbi-mortalidade não desprezível sobretudo nos casos de intestino curto. A maioria das complicações está relacionada com a colocação e cuidados de manutenção dos acessos venosos, podendo ser em grande parte evitadas se os procedimentos forem efetuados por pessoal experiente com protocolos estritos. Palavras-chave: Criança; Nutrição Parentérica; Cateterismo Venoso Central; Cateterismo Periférico. ABSTRACTParenteral nutrition is crucial when the use of the gastrointestinal tract is not feasible. This article addresses the main techniques for parenteral access in children, its indications, insertion details and maintenance, and complications. The type of venous access is mainly dictated by the expected duration of parenteral nutrition and by the body weight/stature. The peripheral access is viable and advantageous for parenteral nutrition of short duration (< 2 weeks); a tunneled central venous catheter (Broviac) is usually necessary in long-term parenteral nutrition (> 3 weeks); a peripherally introduced central catheter is an increasingly used alternative. Parenteral accesses are effective and safe, but the morbidity and mortality is not negligible particularly in cases of short bowel syndrome. Most complications are related to the catheter placement and maintenance care, and can be largely avoided when the procedures are carried out by experienced staff under strict protocols. Keywords: Child; Parenteral Nutrition; Catheterization, Central Venous; Catheterization, Peripheral. INTRODUÇÃOQuando a utilização do trato gastrointestinal é impossível, inadequada ou comporta graves riscos torna-se imperioso o recurso à nutrição artificial por via parentérica. Esta é uma decisão a ser avaliada individualmente e apenas deverá ser implementada se o benefício da melhoria do estado nutricional for compensador face ao risco de complicações graves da nutrição parentérica (NP).Após os estudos de Dudrick et al 1,2 realizados nos finais da década de 60, terem demonstrado que era possível obter crescimento na criança pelo recurso à NP, assistiu-se a uma rápida e crescente utilização desta modalidade terapêutica. Tal resultou na necessidade de se dispor de vias de acesso venoso central, sobretudo nos casos com indic...

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Long-term home parenteral nutrition in children with chronic intestinal failure: A 15-year experience at a single Italian centre

Cited by 61 publications

References 33 publications

Aseptic non‐touch technique and catheter‐related bloodstream infection in children receiving parenteral nutrition at home

Aseptic non‐touch technique and catheter‐related bloodstream infection in children receiving parenteral nutrition at home

Paediatric Home Parenteral Nutrition in the Czech Republic and Its Development: Multicentre Retrospective Study 1995-2011

Vias para Nutrição Artificial na Criança (II): Acessos Parentéricos

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