Prevention of central venous catheter-associated thrombosis in adults on home parenteral nutrition

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Methods to reduce central venous catheter infection are well recognised; however, the prevention of line thrombosis is less well studied” Macdougall et al (2017).

Abstract:

BACKGROUND: Maintaining central access is imperative for the delivery of home parenteral nutrition (HPN) in those with intestinal failure. Methods to reduce central venous catheter infection are well recognised; however, the prevention of line thrombosis is less well studied.

METHODS: This paper reviews the current evidence and reports a survey of current practice within the UK. Using an electronic survey, respondents were asked to detail their use of anticoagulation in different patient groups and the type of anticoagulation used.

RESULTS: 41 replies were received from 31 centres. Only one responder used low-dose warfarin routinely; 80% however anticoagulated those with a previous line thrombosis and 65% anticoagulated those that had any deep vein thrombosis or pulmonary embolus. The most commonly used anticoagulant was dose-adjusted warfarin aiming for an international normalised ratio of 2-3.

CONCLUSIONS: The evidence from the current literature in both HPN and the wider field is that there is no clear evidence that anticoagulation is either beneficial or harmful in the prevention of line thrombosis. This survey suggested that practice is varied across the UK likely reflecting the lack of evidence within the current literature.

Reference:

Macdougall, L., Hanley, J., Mountford, C. and Thompson, N.P. (2017) UK practice in the prevention of central venous catheter-associated thrombosis in adults on home parenteral nutrition. Frontline Gastroenterology. 8(3), p.163-166.

doi: 10.1136/flgastro-2015-100665.

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