title: Going with the flow or swimming against the tide: should children with central venous catheters swim?
abstract: Children who require long-term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life-sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter-related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well-designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence-based recommendation.
authors.affiliation: Kathleen M. Gura, FASHP, FPPAG, Department of Pharmacy, Clinical Nutrition Service, Division of GI/Nutrition, Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Email: kathleen.gura@childrens.harvard.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Miller
authors.forename: Meghan K
authors.initials: MK
authors.lastname: Dalton
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Shirley
authors.initials: S
authors.lastname: Lam
authors.forename: Julie
authors.initials: J
authors.lastname: Iglesias
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gura
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control; D062905:Central Venous Catheters; D002648:Child; D006801:Humans; D010288:Parenteral Nutrition; D010290:Parents; D012307:Risk Factors; D013550:Swimming
keywords: central venous catheters; home parenteral nutrition; nutritional support; parenteral nutrition; pediatrics; sepsis; venous access devices