Catheter Selection in Home Parenteral Nutrition Patients and Noteworthy Definitions in The Diagnosis of Catheter Infections

Öz

The rising number of patients in need of long-term parenteral nutrition has necessitated home parenteral nutrition. Extended usage of central venous catheters and parenteral nutrition has given rise to its own complications. Among them, catheter-related bloodstream infections (CRBSI) are linked to life-threatening complications, especially sepsis, septic shock, and metastatic infections. The principal objective of this review is to define diagnostic methods, notable clinical and laboratory findings, and catheter salvage strategies towards preventing CRBSI, which include defining and interpreting blood culture and its results, its confounding variables and common shortcomings in routine practice. We will discuss the types and relative advantages and disadvantages of differing methods of central venous access and compare the common diagnostic definitions used by existing guidelines. CRBSI remains a serious complication, and we aim to debate when timely intervention will be necessary in light of the existing literature.

Anahtar Kelimeler

• Catheter-related infections
• parenteral nutrition
• home; sepsis

Evde Parenteral Nütrisyon Hastalarında Kateter Seçimi ve Kateter Enfeksiyonu Tanısında Öne Çıkan Tanımlar

Öz

Uzun süreli parenteral beslenmeye ihtiyaç duyan hasta sayısının artması, evde parenteral beslenmeyi zorunlu hale getirmiştir. Uzun süreli santral venöz kateter kullanımı ve parenteral beslenme kendi komplikasyonlarına yol açmıştır. Bunlar arasında kateterle ilişkili kan dolaşımı enfeksiyonları (KİKDE), özellikle sepsis, septik şok ve metastatik enfeksiyonlar gibi yaşamı tehdit eden komplikasyonlarla ilişkilidir. Bu derlemenin ana odağı, kan kültürünün ve sonuçlarının tanımlanması ve yorumlanması, kafa karıştırıcı değişkenler ve rutin uygulamadaki yaygın eksiklikler, KİKDE'yi önlemeye yönelik tanımlar, tanı yöntemleri, önemli klinik ve laboratuvar bulguları ve kateter kurtarma stratejileridir. Farklı santral venöz erişim yöntemlerinin türlerini, göreceli avantaj ve dezavantajları ve mevcut kılavuzların kullandığı tanı kriterleri kıyaslanacaktır. KİKDE ciddi bir komplikasyon olmayı sürdürmektedir ve mevcut literatür ışığında zamanında ivedi müdahalenin ne zaman gerekli olacağını tartışmayı amaçlıyoruz.

Anahtar Kelimeler

• Evde parenteral nütrisyon
• kateter ilişkili enfeksiyon
• sepsis

Kaynakça

1. Broviac JW, Cole JJ, Scribner BH. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet. 1973;136(4):602-606.
2. Millam D. The history of intravenous therapy. J Intraven Nurs. 1996;19(1):5-14.
3. Berger MM, Pichard C. When is parenteral nutrition indicated? J Intensive Med. 2022;2(1):22-28. doi:10.1016/j.jointm.2021.11.006
4. Grainger JT, Maeda Y, Donnelly SC, Vaizey CJ. Assessment and management of patients with intestinal failure: a multidisciplinary approach. Clin Exp Gastroenterol. 2018;11:233-241. doi:10.2147/CEG.S122868
5. Ballanamada Appaiah NN, Boyle K, Rogers D, Stewart J, Baker M. Intestinal Failure: Epidemiology, Catheter-Related Sepsis and Challenges. Cureus. 2021;13(7):e16093. doi:10.7759/cureus.16093
6. Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016;35(2):247-307. doi:10.1016/j.clnu.2016.01.020
7. Gompelman M, Causevic E, Bleeker-Rovers CP, Wanten GJA. Catheter-related bloodstream infection management in patients receiving home parenteral nutrition: An observational cohort study. Clin Nutr ESPEN. 2022;50:155-161. doi:10.1016/j.clnesp.2022.06.003
8. Buchman AL, Opilla M, Kwasny M, Diamantidis TG, Okamoto R. Risk factors for the development of catheter-related bloodstream infections in patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr. 2014;38(6):744-749. doi:10.1177/0148607113491783

9. Forbes A. Achieving and maintaining venous access for home parenteral nutrition. Curr Opin Clin Nutr Metab Care. 2005;8(3):285-289. doi:10.1097/01.mco.0000165007.47073.5e
10. Christensen LD, Rasmussen HH, Vinter-Jensen L. Peripherally inserted central catheter for use in home parenteral nutrition: a 4-year follow-up study. JPEN J Parenter Enteral Nutr. 2014;38(8):1003-1006. doi:10.1177/0148607113512508
11. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45. doi:10.1086/599376
12. Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M, ESPEN. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28(4):365-377. doi:10.1016/j.clnu.2009.03.015
13. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39(4 Suppl 1):S1-S34. doi:10.1016/j.ajic.2011.01.003
14. Bonnes SL, Mundi MS, Hurt RT, Salonen BR. To Pull or Not to Pull: Salvaging Central Line Catheters in Home Parenteral Nutrition. Curr Nutr Rep. 2018;7(4):324-328. doi:10.1007/s13668-018-0245-y
15. Badger J. Long peripheral catheters for deep arm vein venous access: A systematic review of complications. Heart Lung. 2019;48(3):222-225. doi:10.1016/j.hrtlng.2019.01.002
16. Fabiani A, Eletto V, Dreas L, Beltrame D, Sanson G. Midline or long peripheral catheters in difficult venous access conditions? A comparative study in patients with acute cardiovascular diseases. Am J Infect Control. 2020;48(10):1158-1165. doi:10.1016/j.ajic.2019.12.025
17. DeLegge MH, Borak G, Moore N. Central venous access in the home parenteral nutrition population-you PICC. JPEN J Parenter Enteral Nutr. 2005;29(6):425-428. doi:10.1177/0148607105029006425
18. Pollack PF, Kadden M, Byrne WJ, Fonkalsrud EW, Ament ME. 100 patient years’ experience with the Broviac silastic catheter for central venous nutrition. JPEN J Parenter Enteral Nutr. 1981;5(1):32-36. doi:10.1177/014860718100500132
19. Grundfest S, Steiger E. Exerience with the Broviac catheter for prolonged parenteral alimentation. JPEN J Parenter Enteral Nutr. 1979;3(2):45-47. doi:10.1177/014860717900300202
20. Gaggioti G, Orlandoni P, Boccoli G, Capomagi A, Talevi S, Ambrosi S. Percutaneous vs. totally implantable catheters in home parenteral nutrition. Clin Nutr. 1986;5(1):33-40. doi:10.1016/0261-5614(86)90040-3
21. Versleijen MWJ, Huisman-de Waal GJ, Kock MC, et al. Arteriovenous fistulae as an alternative to central venous catheters for delivery of long-term home parenteral nutrition. Gastroenterology. 2009;136(5):1577-1584. doi:10.1053/j.gastro.2009.02.005
22. Society for Clinical Microbiologists of Turkey (KLIMUD). Antibiyotik Duyarlılık Verilerinin Analizi ve Sunumu Rehberi. Çağhan Ofset Matbaacılık Ltd. Şt; 2019. https://www.klimud.org/public/uploads/content/files/Antibiyotik%20Duyarl%C4%B1l%C4%B1k%20Verilerinin%20Analizi%20ve%20Sunumu%20RRehberi.pdf. Accessed March 3, 2024.
23. Başustaoğlu A, Özkütük A, Karakoç A, Arman D, Yılmaz, Ruhsar G. Kan Kültürü Uygulama Kılavuzu KLIMUD. (Başustaoğlu A, ed.).; 2013. https://www.klimud.org/public/uploads/files/KAN%20K%c3%9cLT%c3%9cR%c3%9c%20UYGULAMA%20KLAVUZU.pdf. Accessed March 3, 2024.
24. Society for Clinical Microbiologists of Turkey (KLIMUD). Blood Circulation Samples Laboratory Inspection Guide.; 2022. www.klimud.org/public/uploads/content/files/KLIMUD%20Rehberleri_Kan%20Dolasimi_ver02.pdf. Accessed March 3, 2024.
25. NHSN. Published March 16, 2023. https://www.cdc.gov/nhsn. Accessed August 30, 2023.
26. Members of the Sous les Verrous Study Group. Antibiotic lock therapy for the conservative treatment of long-term intravenous catheter-related infections in adults and children: When and how to proceed? Guidelines for clinical practice 2020. Infect Dis Now. 2021;51(3):236-246. doi:10.1016/j.idnow.2021.02.004
27. Crivelli A, Fabeiro M, Puga M, et al. Care of patients on home parenteral nutrition during the first year of the COVID-19 pandemic: Management of central line-associated bloodstream infections. Clin Nutr ESPEN. 2022;52:250-253. doi:10.1016/j.clnesp.2022.11.003
28. Chadwick PR, Ryan K, Teubner A, Bond A, Abraham A, Lal S. Sensitivity of differential time to positivity compared to pour plates for diagnosing catheter-related blood stream infection: An evaluation in patients with chronic intestinal failure. Clin Nutr. 2020;39(8):2631-2633. doi:10.1016/j.clnu.2019.11.034
29. Catton JA, Dobbins BM, Wood JM, Kite P, Burke D, McMahon MJ. The routine microbiological screening of central venous catheters in home parenteral nutrition patients. Clin Nutr. 2004;23(2):171-175. doi:10.1016/S0261-5614(03)00102-X
30. Dreesen M, Foulon V, Spriet I, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr. 2013;32(1):16-26. doi:10.1016/j.clnu.2012.08.004
31. Reitzel RA, Rosenblatt J, Chaftari AM, Raad II. Epidemiology of Infectious and Noninfectious Catheter Complications in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Meta-Analysis. JPEN J Parenter Enteral Nutr. 2019;43(7):832-851. doi:10.1002/jpen.1609
32. Messing B. Catheter-related sepsis during home parenteral nutrition. Clin Nutr. 1995;14 Suppl 1:46-51. doi:10.1016/s0261-5614(95)80283-5
33. Zhao VM, Griffith DP, Blumberg HM, et al. Characterization of post-hospital infections in adults requiring home parenteral nutrition. Nutrition. 2013;29(1):52-59. doi:10.1016/j.nut.2012.03.010
34. Clare A, Teubner A, Shaffer JL. What information should lead to a suspicion of catheter sepsis in HPN? Clin Nutr. 2008;27(4):552-556. doi:10.1016/j.clnu.2008.04.013
35. Pammi M, Thapa S, Balderas M, Runge JK, Venkatachalam A, Luna RA. Microbiome signatures in neonatal central line associated bloodstream infections. PLoS One. 2020;15(1):e0227967. doi:10.1371/journal.pone.0227967