Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2002-12, Vol.21 (6), p.475-485
• Main Authors: BOZZETTI, F, MARIANI, L, BERTINET, D.BOGGIO, CHIAVENNA, G, CROSE, N, DE CICCO, M, GIGLI, G, MICKLEWRIGHT, A, MORENO VILLARES, J.M, ORBAN, A, PERTKIEWICZ, M, PIRONI, L, VILAS, M.PLANAS, PRINS, F, THUL, P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Catheterization, Central Venous - adverse effects; Catheters, Indwelling - adverse effects; Catheters, Indwelling - microbiology; central venous catheter; CVC complications; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; home parenteral nutrition; HPN complications; Humans; Incidence; Infection - epidemiology; Infection - etiology; Infection Control; Intensive care medicine; Male; Medical sciences; Middle Aged; Parenteral Nutrition, Home; Proportional Hazards Models; Retrospective Studies; Risk Factors; Surveys and Questionnaires; Time Factors
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1054/clnu.2002.0578

Rationale: The purpose of this study is to report the frequency of central venous catheter (CVC) complications and to analyze the potential risk factors for complications requiring CVC removal in home parenteral nutrition (HPN) patients. Methods: A questionnaire developed by the ESPEN HAN WORKING GROUP was distributed to 12 European centers to investigate the complications occurring during the period between January 1995 and December 2000 when HPN patients used their first CVC. The questionnaire collected informations related to the Home Parenteral Nutrition technique and the underlying disease. Factors affecting the time of CVC removal were jointly investigated using Cox's multivariable regression models. Results: The study was performed on 447 patients for a total of 110,869 CVC-days. Complications occurred in about 1/4 of patients, approximately half were infections and about half required Central Venous Catheter removal. The Cox analysis showed that using the CVC 7 times/week and implanted ports were associated with a hazard ratio of 3 and 2.8, respectively. A reduced risk of removal (of about 40%) was associated with using CVC also for non-nutritional purposes ( P = 0.0016). Conclusions: Within the limits of this retrospective investigation, the type of CVC, the type of administration of HPN and the type of training are important factors associated with occurrence of complications or with CVC removal. However, in our opinion, proper care of the CVC, of preparation and administration of the nutritive admixture seem to be paramount for a safe management of HPN.