Venous access for parenteral nutrition: what has changed over the past 12 years?

Abstract

The article provides an overview of the significant changes in clinical practice that have occurred since the publication of the European Association for Clinical Nutrition and Metabolism (ESPEN) guidelines on providing vascular access for parenteral nutrition (PN), regarding the choice of vascular access, prevention and treatment of the most common important complications of long-term venous access - catheter-associated bloodstream infection and obstruction of the internal lumen of the catheters. The preferred vascular access for PN for medium- to long-term PN - a tunneled central venous catheter (TCVC), PICC catheter, or a fully implantable port system (PIPS) - is now largely determined by the underlying disease, near-term prognosis and patient comfort, and with short-term PN in a hospital largely depends on the capabilities of a particular medical institution. Strict adherence to modern standard measures for infection control and care of venous access and infusion lines, hand hygiene, appropriate training of medical personnel, patients and their caregivers are currently the most reliable and effective method of preventing CAIC. Taurolidine catheter lock is used as an additional measure. In most cases, the occlusion of the inner canal of the catheter can be eliminated by the drug method, however, its effectiveness directly depends on the correspondence of the chosen drug to the cause of the occlusion. In general, the changes that have occurred in recent years have significantly reduced the incidence and risk of PN complications associated with vascular access.