Management of Central Venous Catheters in Children and Adults on Home Parenteral Nutrition: A French Survey of Current Practice
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Participation Rate
3.2. Characteristics of Venous Access
3.3. Patient Follow-Up Modalities
3.4. Management of CVC Obstruction
3.5. Management of the Thromboembolic Risk
3.6. Management of Catheter-Related Venous Thrombosis
4. Discussion
4.1. Main Results
4.2. Issues in Pediatrics
4.3. Issues in Adult Centers
4.4. Limitations and Perspectives
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Question | Pediatric Centers (n = 21) | Adult Centers (n = 13) | p |
---|---|---|---|
CVC type | 0.02 | ||
Tunneled catheter only All types (tunneled, PICC line, implantable port) a | 9 (43%) | 0 (0%) | |
12 (57%) | 13 (100%) | ||
Tunneled catheter insertion | |||
Anesthesiologist | 14 (67%) | 4 (31%) | 0.092 |
Radiologist | 0 (0%) | 10 (77%) | <0.01 |
Surgeon | 11 (52%) | 5 (38%) | 0.66 |
Control after CVC insertion | 0.46 | ||
Image intensification | 12 (57%) | 8 (62%) | |
Chest X-ray | 0 (0%) | 1 (8%) | |
Both | 9 (43%) | 4 (31%) | |
Use of a clamp | 0.33 | ||
Always | 12 (57%) | 7 (54%) | |
Sometimes | 1 (5%) | 3 (23%) | |
Never | 8 (38%) | 3 (23%) | |
Use of positive pressure bidirectional valves | 0.50 | ||
Always | 15 (71%) | 7 (54%) | |
Sometimes | 4 (19%) | 4 (31%) | |
Never | 2 (10%) | 2 (15%) | |
Use of antibacterial filters | 0.03 | ||
Always | 10 (48%) | 1 (8%) | |
Sometimes | 3 (14%) | 2 (15%) | |
Never | 8 (38%) | 10 (77%) |
Question | Pediatric Centers (n = 21) | Adult Centers (n = 13) | p |
---|---|---|---|
Patient or caregiver education in detecting complications such as obstruction and thrombosis | 0.85 | ||
Always Sometimes | 14 (67%) | 10 (77%) | |
2 (10%) | 1 (8%) | ||
Never | 5 (24%) | 2 (15%) | |
Venous Doppler ultrasound prescription | 0.37 | ||
Never | 1 (5%) | 0 (0%) | |
Systematic (annual) | 3 (14%) | 0 (0%) | |
On certain indications b | 17 (81%) | 13 (100%) | |
Chest X-ray prescription | 0.23 | ||
Never | 1 (5%) | 1 (8%) | |
Systematic (annual) | 7 (33%) | 1 (8%) | |
On certain indications a | 13 (62%) | 11 (85%) | |
Angio-CT prescription | 0.20 | ||
Never | 9 (43%) | 2 (15%) | |
On certain indications a | 12 (57%) | 11 (85%) | |
Angio-MR prescription | 0.88 | ||
Never a | 16 (76%) | 11 (85%) | |
On certain indications | 5 (24%) | 2 (15%) | |
Blood sampling site | <0.01 | ||
Central (catheter) p | 19 (90%) | 2 (15%) | |
Peripheral | 2 (10%) | 10 (77%) | |
Missing answer | 0 (0%) | 1 (8%) |
Question | Pediatric Centers (n = 21) | Adult Centers (n = 13) | p |
---|---|---|---|
Protocol for restoring CVC patency b | 19 (90%) | 13 (100%) | 0.69 |
Imaging prescription | 0.868 | ||
No | 12 (57%) | 6 (46%) | |
Before the procedure for patency restoration | 8 (38%) | 6 (46%) | |
After the procedure for patency restoration | 1 (5%) | 1 (8%) | |
Molecule for restoring CVC patency | 0.20 | ||
Urokinase a | 14 (67%) | 12 (92%) | |
Other | 7 (33%) | 1 (8%) |
Question | Pediatric Centers (n = 21) | Adult Centers (n = 13) | p |
---|---|---|---|
Search for thrombophilia before HPN onset | 0.76 | ||
Systematic Specific indications | 1 (5%) | 1 (8%) | |
2 (10%) | 0 (0%) | ||
Never b | 18 (86%) | 12 (92%) | |
Search for thrombophilia after a diagnosis of CRT | 0.02 | ||
Systematic | 15 (71%) | 3 (23%) | |
Specific indications | 5 (24%) | 7 (54%) | |
Never | 1 (5%) | 3 (23%) | |
Thromboprophylaxis indications a | 7 (33%) | 2 (15%) | 0.45 |
Long term full-dose anticoagulation | |||
Persistent thrombosis | 7 (33%) | 7 (54%) | 0.41 |
Thrombophilia | 7 (33%) | 8 (62%) | 0.21 |
Question | Pediatric Centers (n = 21) | Adult Centers (n = 13) | p |
---|---|---|---|
Prescription of anticoagulation | 0.07 | ||
Protocolized | 5 (24%) | 2 (15%) | |
Systematic specialist advice | 14 (67%) | 5 (38%) | |
Occasional specialist advice | 2 (10%) | 6 (46%) | |
Specialist advice | <0.01 | ||
Angiologist Hemostasis specialist | 2 (10%) | 8 (62%) | |
12 (57%) | 2 (15%) | ||
Cardiologist/cardio-pediatrician | 7 (33%) | 0 (0%) | |
Missing answer | 0 (0%) | 3 (23%) | |
Treatment duration | 0.27 | ||
<6 weeks | 2 (10%) | 0 (0%) | |
6 weeks–3 months | 7 (33%) | 9 (69%) | |
>3 months | 5 (24%) | 2 (15%) | |
Unspecified | 7 (33%) | 2 (15%) | |
Imaging control | <0.01 | ||
Early (≤1 month) | 11 (52%) | 0 (0%) | |
Late (≥6 weeks or after treatment completion) | 5 (24%) | 8 (62%) | |
Unspecified | 5 (24%) | 5 (38%) | |
Management of asymptomatic thrombosis | 0.02 | ||
Anticoagulation a | 8 (38%) | 11 (85%) | |
No anticoagulation | 2 (10%) | 0 (0%) | |
Request for specialist advice | 11 (52%) | 2 (15%) | |
Systematic anti-Xa activity monitoring p | 21 (100%) | 5 (38%) | <0.01 |
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Gotchac, J.; Poullenot, F.; Guimber, D.; Ecochard-Dugelay, E.; Schneider, S.; Peretti, N.; Billiauws, L.; Borderon, C.; Breton, A.; Chaillou Legault, E.; et al. Management of Central Venous Catheters in Children and Adults on Home Parenteral Nutrition: A French Survey of Current Practice. Nutrients 2022, 14, 2532. https://doi.org/10.3390/nu14122532
Gotchac J, Poullenot F, Guimber D, Ecochard-Dugelay E, Schneider S, Peretti N, Billiauws L, Borderon C, Breton A, Chaillou Legault E, et al. Management of Central Venous Catheters in Children and Adults on Home Parenteral Nutrition: A French Survey of Current Practice. Nutrients. 2022; 14(12):2532. https://doi.org/10.3390/nu14122532
Chicago/Turabian StyleGotchac, Julien, Florian Poullenot, Dominique Guimber, Emmanuelle Ecochard-Dugelay, Stéphane Schneider, Noël Peretti, Lore Billiauws, Corinne Borderon, Anne Breton, Emilie Chaillou Legault, and et al. 2022. "Management of Central Venous Catheters in Children and Adults on Home Parenteral Nutrition: A French Survey of Current Practice" Nutrients 14, no. 12: 2532. https://doi.org/10.3390/nu14122532
APA StyleGotchac, J., Poullenot, F., Guimber, D., Ecochard-Dugelay, E., Schneider, S., Peretti, N., Billiauws, L., Borderon, C., Breton, A., Chaillou Legault, E., Chambrier, C., Comte, A., Coste, M. -E., Djeddi, D., Dubern, B., Dupont, C., Espeso, L., Fayemendy, P., Flori, N., ... Enaud, R. (2022). Management of Central Venous Catheters in Children and Adults on Home Parenteral Nutrition: A French Survey of Current Practice. Nutrients, 14(12), 2532. https://doi.org/10.3390/nu14122532