Management of Central Venous Catheters in Children and Adults on Home Parenteral Nutrition: A French Survey of Current Practice

Vascular rehabilitation in children with chronic intestinal failure reduces the risk of central-line associated bloodstream infections and catheter replacements

BACKGROUND & AIMS

Children with chronic intestinal failure (IF) require a long-term central venous catheter (CVC) for provision of parenteral nutrition. Vascular, mechanical and infectious complications such as central line-associated bloodstream infections (CLABSI) may lead to progressive loss of venous access sites. Handling and management of CVCs therefore play an important role. Our vascular rehabilitation concept (VRC) is a core component of our intestinal rehabilitation program (IRP) and consists of an education program, optimization of skin care, catheter fixation and lock solution, and the use of hybrid technique for catheter placement. Aim of this study is to analyse the effectiveness of our VRC on CLABSI rates and need for CVC replacements.

METHODS

Retrospective analysis of all children treated in our IRP that were followed up between 2018 and 2023.

RESULTS

A total of 117 children with chronic IF could be included for analysis of 248864 catheter days (CD). 91 patients were referred from other hospitals (127117 CD before and 89359 CD after entry into our IRP). Children receiving primary care at our IRP (32388 CD) showed a significantly lower CLABSI and line replacement rate than patients referred from external centers (p < 0.001). After entering our IRP, CLABSI rates and need for CVC replacements per 1000 CD decreased significantly in referred patients: 1.19 to 0.26 and 1.77 to 0.59, respectively (p < 0.001).

CONCLUSION

Management of paediatric chronic IF patients by an IRP with a vascular rehabilitation concept significantly lowers the rate of CLABSI episodes and the need for catheter replacements.

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.

Risk factors for peripherally inserted central venous catheter-related complications in children: A retrospective cohort study

To explore the risk factors for peripherally inserted central venous catheter (PICC)-related complications in children. This retrospective study analyzed data collected from electronic medical records. A total of 584 patients with indwelling PICC treated between January 2019 and August 2021 were included in this study. According to the occurrence of PICC-related complications, the patients without PICC-related complications were included in the control group (n = 538) and those with PICC-related complications were included the observation group (n = 46). The risk factors for PICC-related complications were analyzed. Of the 584 patients with PICCs, 46 (7.88%) had PICC-related complications. Univariate analysis revealed significant differences in venipuncture (P < .001), oozing of blood from the puncture point (P < .001), indwelling time (P < .001), intravenous nutrient solution (P < .001), and catheter type (P = .003). Complications were used as dependent variables. The independent variables were vein puncture, blood oozing at the puncture point, indwelling time, intravenous nutrient solution, and catheter type. Multivariate logistic regression analysis revealed that the vein puncture (odds ratio [OR] 10.115, 95% confidence interval [CI] 5.034-20.323, P < .001), puncture point blood oozing (OR 9.217, 95% CI 3.860-22.004, P < .001), indwelling time (OR 6.390, 95% CI 3.527-10.972, P = .005), intravenous nutrient solution (OR 2.593, 95% CI 1.675-4.015, P < .001), and catheter type (OR 8.588, 95% CI 2.048-19.095, P = .013) were all risk factors for PICC-related complications in children. Venipuncture, oozing of blood from the puncture point, indwelling time, intravenous nutrient solution, and catheter type are risk factors for PICC-related complications in children. Significant attention should be paid to whether the puncture point is bleeding, the presence or absence of an intravenous nutrient solution, duration of catheterization, type of catheterization, and venipuncture. Additionally, preventive nursing measures should be implemented as soon as possible to reduce the risk of complications related to peripheral PICC.