ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters (access, care, diagnosis and therapy of complications)

Mauro Pittiruti, Helen Hamilton, Roberto Biffi, John MacFie, Marek Pertkiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion and maintenance. These too depend on appropriate choice of device, skilled implantation and correct positioning of the catheter, adequate stabilization of the device (preferably avoiding stitches), and the use of infusion pumps, as well as adequate policies for flushing and locking lines which are not in use.{A table is presented}.

Original languageEnglish
Pages (from-to)365-377
Number of pages13
JournalClinical Nutrition
Volume28
Issue number4
DOIs
Publication statusPublished - Aug 2009

Keywords

  • Antibiotic lock therapy
  • Catheter-related bloodstream infection
  • Catheter-related venous thrombosis
  • Central venous access
  • Central venous catheters
  • Chlorhexidine
  • Clinical practice
  • Evidence-based
  • Exchange over guide wire
  • Fibrin sleeve
  • Guidelines
  • Heparin lock
  • Home parenteral nutrition
  • Midline catheters
  • Needle-free connectors
  • Parenteral nutrition
  • Peripheral parenteral nutrition
  • PICC
  • Pinch-off syndrome
  • Sutureless securing devices
  • Totally implantable ports
  • Tunneled catheters
  • Ultrasound guidance
  • Venous access devices

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

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