ESPEN 2012 - Late breaking abstract submission
Topic: Late Breaking Abstract
Abs n°:ESPEN12-1923
Abs Title: CENTRAL VENUS CATHETER REPLACEMENT IN 27 PAEDIATRIC PATIENTS ON LONG TERM PARENTERAL NUTRITION: 116 PATIENT YEARS OF EXPERIENCE.
K. Dimakou 1,*J. Ish-Horowicz 1S. Hill 1
1paediatric gastroenterology, great ormond street hospital, london, United Kingdom
Rationale: Central Venous Catheter (CVC) related complications increase mortality and morbidity in long term parenteral nutrition(PN) patients.We investigated the life span of CVCs and evaluated the factors influencing CVC removal in a population of children receiving long term PN.
Methods: The medical in- and out-patient records of 27 children (52% male,mean age 7,range 1.8-17 years) currently receiving follow-up in a specialist Home PN clinic were reviewed to determine the frequency of and reasons for CVC replacements. Parents were trained to manage catheter care at home.
Results: There were 89 CVC replacement episodes in 27 children (34 for line associated infections,14 catheter migration,14 due to catheter damage,14 elective replacements,10 for catheter occlusion and 3 for unspecified reasons). Overall incidence of line replacement was 2.3/1000 CVC days.The life span of the CVCs was on average 80 days(range 7-493) when inpatients and 451 days(range 1-3323) when discharged home. The survival analysis model performed indicated significant increased life span of CVC with home PN (52 episodes, 1.5/1000 catheter days) compared to inpatient PN administration(37 episodes, 7.8/1000 catheter days), p=0.035 with older age, p=0.004 and increasing size of the catheter lumen, p=0.05 but there was no correlation with patients sex or weight,type or previous number of CVCs and underlying diagnosis(11 enteropathy,10 dysmotility,6 short gut).
Conclusion: A similar number of CVCs were replaced for mechanical (migration, damage, occlusion) and infectious reasons. CVC replacement influences the morbidity of children on long term PN. Despite their negative effect on CVC survival, small size catheters are indicated due to the age and size of patients. In contrast training parents to provide PN treatment at home is of significant benefit with of a 5-fold reduction in incidence of CVC replacements.
Disclosure of Interest: None Declared
Keywords: Central venous catheterparenteral nutrition