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CVC repair in home parenteral nutrition patients

"This is the largest single-centre experience to demonstrate that CVCs, including PICCs, used for the administration of HPS, can be safely repaired prolonging CVC longevity without leading to an increased risk of CRBSI" Bond et al (2023).

"This is the largest single-centre experience to demonstrate that CVCs, including PICCs, used for the administration of HPS, can be safely repaired prolonging CVC longevity without leading to an increased risk of CRBSI" Bond et al (2023).

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CVC repair in home parenteral nutrition patients

Abstract:

Introduction: Central venous catheter (CVC) complications are frequently reported in patients receiving home parenteral support (HPS). Compromised CVC integrity or breakage is one such issue. Repairing such breakages can potentially avoid costly and risky catheter replacements.

Method: We completed a retrospective descriptive cohort study utilising a prospectively maintained dataset, in a national U.K. intestinal failure reference centre. Repair success, CVC longevity and catheter-related blood stream infection (CRBSI) rates after repair were the primary outcome measures.

Result: During the study period, a total of 763 patients received HPS. There were 137 CVC repairs (115 (84%) tunnelled CVCs, 22 peripherally-inserted central catheters attempted in 72 patients. Of the 137 attempts at CVC repair, 120 (88%) were deemed to be successful; allowing a median duration of subsequent CVC use of 336 days following repair (range 3-1696 days), which equates to 99 602 catheter days of HPS infusion. Three patients suffered from a CRBSI within 90 days of repair and patients required admission to hospital for refeeding on 14 occasions following repair, such that hospitalization was avoided in 103/120 (86%) occasions following successful CVC repair. There was no increase in the recorded rate of CRBSIs in patients undergo CVC repair compared to the CRBSI of all HPS-dependent patients under our care during the study period (0.03 vs 0.344/1000 catheter days, respectively).

Conclusion: This is the largest single-centre experience to demonstrate that CVCs, including PICCs, used for the administration of HPS, can be safely repaired prolonging CVC longevity without leading to an increased risk of CRBSI.


Reference:

Bond A, Hall K, Taylor M, Duxbury A, Cawley C, Abraham A, Teubner A, Lal S. Outcomes for central venous catheter repair in patients receiving long term home parenteral support: A descriptive cohort study. JPEN J Parenter Enteral Nutr. 2023 Dec 23. doi: 10.1002/jpen.2594. Epub ahead of print. PMID: 38142305.

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