INVESTIGATION OF URGENT REASONS FOR CENTRAL VENOUS CATHETER REPLACEMENTS AND OUTCOMES IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTS.

Unal, K.N.; Park, T.; Lopez, L.G.; Goldthorpe, J.; Cernat, E.

INVESTIGATION OF URGENT REASONS FOR CENTRAL VENOUS CATHETER REPLACEMENTS AND OUTCOMES IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTS.

All Authors

Unal, K.N.

Park, T.

Lopez, L.G.

Goldthorpe, J.

Cernat, E.

LTHT Author

Unal, Kubra Nur
Park, Tara
Gomez Lopez, Lilianne
Goldthorpe, Jenny
Cernat, Elena

LTHT Department

Doctors' Rotation
Leeds Children's Hospital
Paediatric Nutrition
Children's Services
Nephrology, Hepatology & Gastroenterology
Paediatric Gastroenterology

Non Medic

Dietitian
Children's Nutrition & Ibd Nurse Specialist Team Manager

Publication Date

2025

Item Type

Conference Abstract

Abstract

Patients with intestinal failure (IF) require central venous catheters (CVC) for administration of long-term parenteral nutrition (PN). The presence of a CVC is a major risk factor for severe complications like central line associated bloodstream infections (CLABSIs), thrombosis and mechanical complications (occlusions, fractures or displacements) which can require an urgent CVC replacement. The aim of this study was to investigate urgent reasons for CVC replacement and outcomes in paediatric Home PN (HPN) patients. Retrospective data was collected from electronic notes of patients receiving HPN from January 2022 to September 2023. From 27 patients managed with HPN during that interval (6 started during that period, one stopped PN and one transitioned to adults), 11 patients (7 females) with a median age of 12 years 1 month [IQR 7 y 1 m - 13 y 9 m] required acute line changes. 3 patients had multiple line changes during this period (two had 2 changes and one had 3 changes), so in total we describe 15 acute CVC changes. At the time of the change, the median of the PN nights was 7 nights given over a median of 12 hours [IQR 12 - 24 hours]. Indications for HPN in these patients were short bowel syndrome (4 cases), gut dysmotility (5 cases) and microvillus inclusion disease (2 cases). PN was delivered through a single lumen tunnelled CVC except for one patient who had a double lumen CVC. The CVCs were locked with Taurolock in most of the cases (except one patient with Taurolock allergy). 6 981 catheter days were evaluated during the study period. Causes for acute line changes were: CLABSIs (4 cases - 2 Candida, 2 Staphylococcus aureus) and one exit site infection, followed by mechanical complications - broken lines (4 cases), displacements (4 cases) and occlusion (1 case). The infection rate was 0.57 per 1000 catheter days. Line changes were performed by paediatric surgery in 9 cases and interventional radiology in 4 of the patients. The median time between admission and line change was 2 days [IQR 1 -3 days]. The median length of admission for line change was 3 days [IQR 3 - 7.5 days]. The length of admission increased for patients who needed a line change due to CLABSIs due to antibiotic treatment. In patients who underwent more than one line change, the change was due to mechanical complications, 3/4 displacements being seen in patients with learning difficulties. In conclusion, although the CVC related complications have decreased over the years due to medical advances and multidisciplinary team approach, these are still happening in paediatric HPN patients. Some of the CVC replacements are done acutely and our study showed the reason for the change can be related with comorbidities (e.g. learning difficulties, severe IF with 24 hours PN dependency).