Venous access for parenteral nutrition: what has changed over the past 12 years?

Clinical nutrition and metabolism ◽

10.17816/clinutr79378 ◽

2021 ◽

Author(s):

Olga A. Obukhova ◽

Ildar A. Kurmukov

Keyword(s):

Parenteral Nutrition ◽

Vascular Access ◽

Venous Catheter ◽

Medical Personnel ◽

Venous Access ◽

Underlying Disease ◽

Patient Comfort ◽

Additional Measure ◽

Strict Adherence

The article provides an overview of the significant changes in clinical practice that have occurred since the publication of the European Association for Clinical Nutrition and Metabolism (ESPEN) guidelines on providing vascular access for parenteral nutrition (PN), regarding the choice of vascular access, prevention and treatment of the most common important complications of long-term venous access - catheter-associated bloodstream infection and obstruction of the internal lumen of the catheters. The preferred vascular access for PN for medium- to long-term PN - a tunneled central venous catheter (TCVC), PICC catheter, or a fully implantable port system (PIPS) - is now largely determined by the underlying disease, near-term prognosis and patient comfort, and with short-term PN in a hospital largely depends on the capabilities of a particular medical institution. Strict adherence to modern standard measures for infection control and care of venous access and infusion lines, hand hygiene, appropriate training of medical personnel, patients and their caregivers are currently the most reliable and effective method of preventing CAIC. Taurolidine catheter lock is used as an additional measure. In most cases, the occlusion of the inner canal of the catheter can be eliminated by the drug method, however, its effectiveness directly depends on the correspondence of the chosen drug to the cause of the occlusion. In general, the changes that have occurred in recent years have significantly reduced the incidence and risk of PN complications associated with vascular access.

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

Acta Médica Portuguesa ◽

10.20344/amp.5313 ◽

2014 ◽

Vol 27 (6) ◽

pp. 767

Author(s):

José Estevão-Costa

Keyword(s):

Parenteral Nutrition ◽

Central Venous Catheterization ◽

Venous Catheter ◽

Venous Access ◽

The Body ◽

Central Catheter ◽

Maintenance Care ◽

Central Venous ◽

Venous Catheterization

Parenteral 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<br />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.<br /><strong>Keywords:</strong> Child; Parenteral Nutrition; Catheterization, Central Venous; Catheterization, Peripheral.

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Central venous thrombosis in patients receiving long-term parenteral nutrition

Applied Physiology Nutrition and Metabolism ◽

10.1139/h07-153 ◽

2008 ◽

Vol 33 (1) ◽

pp. 32-38 ◽

Cited By ~ 8

Author(s):

Donald R. Duerksen

Keyword(s):

Parenteral Nutrition ◽

Venous Thrombosis ◽

Vitamin K ◽

Central Venous Access ◽

Anticoagulation Therapy ◽

Venous Catheter ◽

Venous Access ◽

Central Venous ◽

Central Venous Thrombosis

Long-term parenteral nutrition (PN) is administered to patients who are unable to use their gastrointestinal tract to absorb sufficient nutrients and water to maintain their nutritional status. Patients receiving long-term parenteral nutrition are at risk of numerous complications including thrombosis of the central venous catheter used to provide nutrition. Central venous access is essential to the successful delivery of long-term PN. One of the strategies to lessen the frequency of this complication is anticoagulation therapy with warfarin. The effect of warfarin in preventing this complication may be modified by vitamin K intake. Individuals with gastrointestinal failure may receive vitamin K from a variety of sources. This review summarizes the role of warfarin in preventing central venous access thrombosis. It also summarizes potential sources of vitamin K intake in home parenteral nutrition patients, examines the evidence for recommendations regarding vitamin K intake, and considers the potential impact of increased vitamin K intake on home PN patients, particularly on the prevention of central venous thrombosis.

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How to perform appropriate flushing after lipid emulsion administration using totally implantable venous access devices in long-term total parenteral nutrition and home parenteral nutrition

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.11.019 ◽

2020 ◽

Author(s):

Naoya Okamura ◽

Takae Yamato ◽

Ippei Yamaoka ◽

Kazuhisa Doi ◽

Yu Koyama

Keyword(s):

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Lipid Emulsion ◽

Venous Access ◽

Home Parenteral Nutrition ◽

Venous Access Devices

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Long term venous access for intermitient parenteral nutrition: Advantage of totally implantable central venous access systems

Clinical Nutrition ◽

10.1016/0261-5614(86)90284-0 ◽

1986 ◽

Vol 5 ◽

pp. 165

Keyword(s):

Parenteral Nutrition ◽

Central Venous Access ◽

Venous Access ◽

Central Venous

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Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101094 ◽

2019 ◽

Vol 11 (1) ◽

pp. 48-54 ◽

Cited By ~ 3

Author(s):

Ashley Bond ◽

Paul Chadwick ◽

Trevor R Smith ◽

Jeremy M D Nightingale ◽

Simon Lal

Keyword(s):

Parenteral Nutrition ◽

Bloodstream Infections ◽

Venous Catheter ◽

Nutrition Support ◽

Central Venous ◽

Short Term ◽

Qualitative And Quantitative ◽

Central Venous Catheter Removal ◽

Support Team

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.

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High rate of native arteriovenous fistulas: How to reach this goal?

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1504226j ◽

2015 ◽

Vol 143 (3-4) ◽

pp. 226-229

Author(s):

Tamara Jemcov ◽

Marija Milinkovic ◽

Igor Koncar ◽

Ilija Kuzmanovic ◽

Nenad Jakovljevic ◽

...

Keyword(s):

Vascular Access ◽

Continuous Process ◽

Venous Catheter ◽

Medical Personnel ◽

High Rate ◽

Central Venous ◽

Vascular Surgeon ◽

Arteriovenous Fistulas ◽

Clinical Center

The types of vascular accesses for hemodialysis (HD) include the native arteriovenous fistula (AVF), arteriovenous graft (AVG) and central venous catheter (CVC). Adequately matured native AVF is the best choice for HD patients and a high percentage of its presence is the goal of every nephrologist and vascular surgeon. This paper analyses the number and type of vascular accesses for HD performed over a 10-year period at the Clinical Center of Serbia, and presents the factors of importance for the creation of such a high number of successful native AVF (over 80%). Such a result is, inter alia, the consequence of the appointment of the Vascular Access Coordinator, whose task was to improve the quality of care of blood vessels in the predialysis period as well as of functional vascular accesses, and to promote the cooperation among different specialists within the field. Vascular access is the ?lifeline? for HD patients. Thus, its successful planning, creation and monitoring of vascular access is a continuous process that requires the collaboration and cooperation of the patient, nephrologist, vascular surgeon, radiologist and medical personnel.

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Advanced vascular access

Paediatric Anaesthesia ◽

10.1093/med/9780198755791.003.0010 ◽

2019 ◽

pp. 177-190

Author(s):

Richard Craig

Keyword(s):

Vascular Access ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Short Term ◽

Central Lines ◽

Venous Access Devices

In this chapter, the use of ultrasound to facilitate cannulation of a vessel is described in detail, including commentaries on equipment, preparation, scanning, and needling technique. Equipment and techniques for the insertion of short-term non-tunnelled central lines, long-term central venous access devices, arterial lines, and intraosseous needles are presented.

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A Five-Year Data Report of Long-Term Central Venous Catheters Focusing on Early Complications

Anesthesiology Research and Practice ◽

10.1155/2019/6769506 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Harald Lenz ◽

Kirsti Myre ◽

Tomas Draegni ◽

Elizabeth Dorph

Keyword(s):

Demographic Data ◽

Venous Catheter ◽

Venous Access ◽

Seldinger Technique ◽

Published Data ◽

Main Diagnosis ◽

Anatomical Landmarks ◽

Central Venous ◽

Jugular Veins

Background. Long-term venous access has become the standard practice for the administration of chemotherapy, fluid therapy, antibiotics, and parenteral nutrition. The most commonly used methods are percutaneous puncture of the subclavian and internal jugular veins using the Seldinger technique or surgical cutdown of the cephalic vein. Methods. This study is based on a quality registry including all long-term central venous catheter insertion procedures performed in patients >18 years at our department during a five-year period. The following data were registered: demographic data, main diagnosis and indications for the procedure, preoperative blood samples, type of catheter, the venous access used, and the procedure time. In addition, procedural and early postoperative complications were registered: unsuccessful procedures, malpositioned catheters, pneumothorax, hematoma complications, infections, nerve injuries, and wound ruptures. The Seldinger technique using anatomical landmarks at the left subclavian vein was the preferred access. Fluoroscopy was not used. Results. One thousand one hundred and one procedures were performed. In eight (0.7%) cases, the insertion of a catheter was not possible, 23 (2.1%) catheters were incorrectly positioned, twelve (1.1%) patients developed pneumothorax, nine (0.8%) developed hematoma, and three (0.27%) developed infection postoperatively. One (0.1%) patient suffered nerve injury, which totally recovered. No wound ruptures were observed. Conclusions. We have a high success rate of first-attempt insertions compared with other published data, as well as an acceptable and low rate of pneumothorax, hematoma, and infections. However, the number of malpositioned catheters was relatively high. This could probably have been avoided with routine use of fluoroscopy during the procedure.

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