According to the ESPEN and ASPEN guidelines, in the case of a long-term (>3-month) parenteral nutrition should be administered via a subcutaneous central venous catheter (CVC). There are three types of mechanical complications of tunnelled central catheter: catheter rupture, occlusion by TPN depositing and thrombofibrotic occlusion.
The aim of the study was to analyse the incidence of complications central catheter in a group of patients receiving HPN.
Material and methods. Between January 2010 and June 2014, HPN was conducted in 584 patients (306 women and 278 men), ninety-nine patients were enrolled in the study: 67 women and 32 men in whom mechanical complications of central catheters were found.
Results. Among 99 patients, 71 used the tunnelled Broviac catheter. Groshong catheters were placed only in patients receiving parenteral nutrition due to cancer. Analyses have shown differences between the older and younger in the number of mechanical complications. Younger patients were found to have a larger number of catheter complications (1.6 ± 1.1) in comparison with older patients (1.3 ± 0.7). The catheter that was most commonly damaged was the Broviac catheter 76.8%. The most frequent type of mechanical complications was catheter rupture 64.81%.
Conclusions. Mechanical complications of tunnelled central catheters in HPN patients can be repaired in an outpatient setting in half of the cases, which enables continuation of parenteral nutrition without the need to hospitalise the patient. The centres that conduct HPN should offer 24-hour care and help in case of problems with the central venous line to the patients.
1. Polnik D, Kaliciński P, Kornacka MK et al.: Guidelines for the use of special purposes central vein catheters (Broviac, Hickman and Gronshong): proposals for recommendations. Med Wieku Rozwoj 2008 Oct-Dec; 12 (4 Pt 1): 875-77.
2. Van Gossum A: Home Parenteral Nutrition in Europe. W: Home Parenteral Nutrition, F. Bozzetti, M. Staun, A. Van Gossum (red). CAB International 2006, New York, USA.
3. Ugur A, Marashdeh BH, Gottschalck I et al.: Home parenteral nutrition in Denmark in the period from 1996 to 2001. Scand J Gastroenterol. 2006 Apr; 41 (4): 401-07.
4. Staun M, Pironi L, Bozzetti F et al.: ESPEN Guidelines on Parenteral Nutrition: home parenteral nutrition (HPN) in adult patients. Clin Nutr 2009 Aug; 28 (4): 467-79.
5. Pittiruti M, Hamilton H, Biffi R et al.: ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009 Aug; 28 (4): 365-77.
6. Pertkiewicz M: Powikłania zakrzepowe związane z dostępem do żył centralnych. Postępy Żywienia Klinicznego Nr 1/2008 (7); t. 3: 38-41.
7. Richards DM, Deeks JJ, Sheldon TA, Shaffer JL: Home parenteral nutrition: a systematic review. Health Technology Assessment 1997; 1: 1-47.
8. Silberzweig JE, Sacks D, Azita S: The members of the Society of Interventional Radiology Technology Assessment Committee. Reporting standards for central venous access. J Vasc Intern Radiol 2003; 14: S443-52.
9. Pittiruti M, Buononato M, Malerba M et al.: Which is the easiest and safest technique for central venous access? A retrospective survey of more than 5,400 cases. J Vasc Access 2000; 1: 100-07.
10. Letachowicz K, Letachowicz W, Weyde W et al.: Repair of damaged connectors of tunneled cuffed catheters with a two-piece adaptor for peritoneal dialysis. J Vasc Access 2012 Apr-Jun; 13 (2): 203-07.
11. East D, Jacoby K: The effect of a nursing staff education program on compliance with central line care policy in the cardiac intensive care unit. Pediatric Nursing 2005; 31: 182-84.
12. Winkler M, Guenter P: Long-term home parenteral nutrition: it takes an interdisciplinary approach. J Infus Nurs 2014 Sep-Oct; 37 (5): 389-95.
13. Reusch S, Walder B, Tramer MR: Complications of central venous catheters: internal jugular versus subclavian access – a systematic review. Critical Care Med 2002; 30: 454–60.
14. Hamilton HC, Foxcroft DR: Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy. Cochrane Database of Systematic Rev 2007; (3).
15. Jacobs BR, Schilling S, Doellman D et al.: Central venous catheter occlusion: a prospective, controlled trial examining the impact of a positivepressure valve device. J Parent and Enteral Nutrit 2004; 28: 113-18.
16. Dal Molin A, Allara E, Montani D et al.: Flushing the central venous catheter: is heparin necessary? J Vasc Access 2014 Jul-Aug; 15 (4): 241-48.
17. Goode CJ, Titler M, Rakel B et al.: A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Nursing Research 1991; 40: 324-30. 61.
18. Peterson FY, Kirchoff KT: Analysis of the research about heparinized versus nonheparinized intravascular lines. Heart and Lung 1991; 20: 631-40. 62.
19. Silvers KM, Darlow BA, Winterbourn CC: Pharmacologic levels of heparin do not destabilize neonatal parenteral nutrition. J Parenter Enteral Nutr 1998 Sep-Oct; 22 (5): 311-14.
20. Silvers KM, Winterbourn CC: The destabilisation of total parenteral nutrition by heparin. How real is the problem? N Z Med J 1997 Oct 10; 110 (1053): 386.
21. Rattenbury JM, Taylor CJ, Ganapathy S: Lipid deposition in parenteral infusion lines. Lancet 1988 Mar 26; 1 (8587): 701.