title: [Catheter occlusion and venous thrombosis prevention and incidence in adult home parenteral nutrition (HPN) programme patients].
abstract: In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial.
  
  
  OBJECTIVE
  To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country.
  
  
  METHODS
  Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008.
  
  
  RESULTS
  49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/10³ and 0.115/10³ HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism.
  
  
  CONCLUSIONS
  [corrected] The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and catheter related venous thrombosis. In conclusion, it would be necessary to standardize practice.
authors.affiliation: Unidad de Soporte Nutricional, Hospital Universitari Vall d'Hebrón, Barcelona, España.
authors.forename: C
authors.initials: C
authors.lastname: Puiggròs
authors.forename: C
authors.initials: C
authors.lastname: Cuerda
authors.forename: N
authors.initials: N
authors.lastname: Virgili
authors.forename: M L
authors.initials: ML
authors.lastname: Chicharro
authors.forename: C
authors.initials: C
authors.lastname: Martínez
authors.forename: C
authors.initials: C
authors.lastname: Garde
authors.forename: D
authors.initials: D
authors.lastname: de Luis
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002405:Catheterization, Central Venous; D057785:Catheters / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin