Repair of damaged central venous catheters is safe and doubles catheter survival: a home parenteral nutrition patient cohort study

Autor: Renate K. Vissers, Wietske Kievit, Geert J. A. Wanten, Hans Groenewoud, Yannick Wouters
Rok vydání: 2019
Předmět:
Adult
Male
0301 basic medicine
Catheterization
Central Venous
medicine.medical_specialty
medicine.medical_treatment
Stress-related disorders Donders Center for Medical Neuroscience [Radboudumc 13]
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
030209 endocrinology & metabolism
Critical Care and Intensive Care Medicine
Rate ratio
Tertiary Care Centers
03 medical and health sciences
0302 clinical medicine
Interquartile range
medicine
Central Venous Catheters
Humans
Aged
Retrospective Studies
030109 nutrition & dietetics
Nutrition and Dietetics
business.industry
Incidence (epidemiology)
Middle Aged
Surgery
Intestinal Diseases
Catheter
Parenteral nutrition
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Catheter-Related Infections
Cohort
Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5]
Equipment Failure
Female
Parenteral Nutrition
Home
business
Central venous catheter
Cohort study
Zdroj: Clinical Nutrition, 38, 4, pp. 1692-1699
Clinical Nutrition, 38, 1692-1699
ISSN: 0261-5614
Popis: Contains fulltext : 205360.pdf (Publisher’s version ) (Closed access) BACKGROUND & AIMS: Repeated central venous catheter loss due to complications, including material breakage, compromises the options to obtain adequate vascular access in home parenteral nutrition (HPN) patients. It remains unclear whether repair of damaged catheters is an effective strategy to extend catheter survival, avoid surgical replacement and maintain venous access. The aim of this study was to evaluate the effectiveness and safety of catheter repair in our cohort of intestinal failure patients. METHODS: We conducted a retrospective analysis of all catheter repairs that were performed between 2006 and 2017 at our tertiary referral centre for intestinal failure. Primary outcome was the additional median catheter survival after catheter repair, as calculated with Kaplan-Meier analyses. Secondary outcomes included risk for central line-associated bloodstream infections (CLABSIs) and risk factors for catheter damage, as calculated with Poisson regression analyses. CLABSI rates in post-repair periods were compared with pre-repair periods. Pre- and post-repair periods were either short-term (30 days), or long-term (whole catheter period). RESULTS: A total of 58 repairs in 41 catheters of 35 HPN patients were included in the analysis. The median time to first repair was 452 days (interquartile range (IQR) 206-1134). After first repair, catheter survival additionally increased by 510 days (IQR 147-1195). Repairs did not increase the short-term risk for CLABSIs: incidence rates were 1.23 and 1.26 CLABSIs/1000 catheter days for the 30 days pre- and post-repair periods, respectively (rate ratio, 1.05; 95%CI, 0.15-7.44; P = 0.96). For the whole pre- and post-repair catheter period, incidence rates were 0.12 and 0.59 CLABSIs/1000 catheter days, respectively (rate ratio, 3.55; 95%CI, 1.10-11.45; P = 0.03). The overall CLABSI incidence rates in undamaged versus repaired catheters were 0.84 and 0.31 CLABSIs/1000 catheter days, respectively (rate ratio, 0.47; 95%CI, 0.23-0.94; P = 0.03). A lower age at catheter start and femoral catheterization were associated with a higher risk for catheter damage. CONCLUSIONS: Repair of damaged catheters is often successful and an effective strategy to prolong and maintain venous access in HPN patients. On the short-term, no increase in CLABSI incidence was observed. Despite a possible increase in CLABSI incidence on the long-term, overall CLABSI rates of repaired catheters remained well below the overall CLABSI incidence of undamaged catheters. The identification of two risk factors for catheter damage may help to prevent future catheter damage.
Databáze: OpenAIRE
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