Venous access for parenteral nutrition: Changes in Europe and North America over the past 12 years

Abstract

This article provides an overview of the significant changes in clinical practices since the publication of the European Association for Clinical Nutrition and Metabolism guidelines on providing vascular access for parenteral nutrition regarding the choice of vascular access and prevention and treatment of the most common and important complications of long-term venous access, the catheter-associated bloodstream infection, and internal lumen obstruction of catheters. The preferred vascular access for parenteral nutrition for medium- to long-term parenteral nutrition is the tunneled central venous catheter, peripherally inserted central catheter, or a fully implantable port system, which is now largely determined by the underlying disease, near-term prognosis and patient comfort, and short-term parenteral nutrition in a hospital that 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, and appropriate training of medical personnel, patients, and their caregivers are currently the most reliable and effective methods to prevent catheter-associated bloodstream infection. 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 drug methods; however, its effectiveness directly depends on the correspondence of the chosen drug to the cause of the occlusion. Generally, changes in recent years have significantly reduced the incidence and risk of parenteral nutrition complications associated with vascular access.