title: A comparison of two methods of treatment for central catheter tunnel phlegmon in home parenteral nutrition patients.
abstract: BACKGROUND
  The ESPEN guidelines on long-term (> 3 months) parenteral nutrition recommend the use of tunnelled central venous catheters (CVCs) to minimise the risk of insertion site infection. A developed symptomatic infection of the soft tissue tunnel surrounding a CVC may rapidly become directly life threatening if the infection progresses along the catheter tunnel towards its end inserted into the venous system. This requires immediate management to eliminate infection and limit its effects.
  
  
  OBJECTIVE
  To compare two surgical techniques for the treatment of suppurative inflammation of a CVC tunnel: conventional drainage of the infected tissues (surgical technique A) vs. radicalen blocexcision of the infected tissues together with the infected central catheter (surgical technique B).
  
  
  METHODS
  Seventy-three patients hospitalised due to CVC tunnel phlegmon between April 2004 and May 2014 were included in the retrospective study. Thirty-four (46.5%) patients underwent surgical procedure A and another 39 (53.5%) underwent procedure B.
  
  
  RESULTS
  The mean duration of antibiotic therapy following procedure A was 8 ±3 days, whereas procedure B required 7 ±2 days of antibiotic therapy (NS). The mean hospitalisation period following procedure B was over 8 days shorter in comparison to that following procedure A (16.54 ±7.59 vs. 24.87 ±10.19,p= 0.009, respectively).
  
  
  CONCLUSIONS
  The surgical treatment of CVC tunnel phlegmon involving radicalen blocexcision of suppurated tissues along with the infected CVC shortens hospitalisation, expedites the insertion of a new CVC, and potentially reduces treatment costs.
authors.affiliation: Department of General Surgery and Clinical Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Ławiński
authors.affiliation: Department of General and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Karol
authors.initials: K
authors.lastname: Forysiński
authors.affiliation: Department of Human Nutrion, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Bzikowska
authors.affiliation: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Justyna Z
authors.initials: JZ
authors.lastname: Kostro
authors.affiliation: Department of Personality, University of Social Sciences and Humanities, Warsaw, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Gradowska
authors.affiliation: Department of General Surgery and Clinical Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Pertkiewicz
keywords: parenteral nutrition; tunnel catheter phlegmon