2016 HomePN Research Prize Winners
The HomePN Research Prize, sponsored by Nutrishare, Inc., was established in 2007 to encourage clinical studies focused on improving the quality of life for home parenteral nutrition (HPN) consumers. The 2016 prizes will be awarded to the following individuals at Oley’s annual Consumer/Clinician Conference in Newport Beach, California, in July. Each winner will receive a $2,500 award and be invited to present their research at the conference. We look forward to hearing them discuss their research!
To Swim or Not to Swim: Survey on Swimming Practices with a Central Venous Catheter
Carol Cheney, ThriveRx, Cincinnati, Ohio
Quality of life issues are important to those on long-term home parenteral nutrition (HPN). One issue of concern is swimming while having a central venous catheter (CVC) in place. There is very limited published research and a lack of evidence-based recommendations in this area. As a result, a survey was designed to identify attitudes and practices of HPN consumers surrounding swimming with a CVC.
For this study, an anonymous electronic survey was distributed to the HPN community via social media. The survey consisted of eleven questions about swimming with a CVC and specific practices of CVC care. The survey also asked about how aware the consumer’s medical team was of the patient’s swimming practices.
One hundred eighty-two consumers with a CVC responded. Of these, 158 (87%) reported that swimming was important to them and 101 (55%) reported actually swimming with a CVC. Of the swimmers, 71 reported swimming in a pool; 24 reported swimming in the ocean; 5 reported swimming in a lake; and 11 reported swimming in all three.
As for line care, 62 (61%) of the swimmers wore CVC protective covering during swimming; 16 of these wore wetsuits. Thirty-six (36%) reported not wearing any protective covering. Two did not respond to the question.
Sixty-one (60%) of the swimmers reported changing their dressing immediately after swimming; 36 (36%) reported changing the dressing as needed; 2 did not respond to the question.
Ninety-four (93%) of the swimmers reported having zero CVC infections after swimming; 6 (6%) reported one CVC infection after swimming; 1 (1%) reported two CVC infections after swimming. Of those reporting infections, all but 1 reported wearing a CVC protective covering and 6 reported changing their CVC dressing immediately after swimming.
Of the 101 swimmers, 63 (62%) reported that their medical team knew they swam, with 43 (68%) of these informed teams allowing swimming and 20 (32%) of these teams prohibiting swimming. Thirty-eight (38%) swimmers reported that their team was not aware of the activity.
The study concluded that consumer practice of swimming with a CVC varies by swimming location, care of the CVC during and after the activity, and notification of the medical team regarding swimming practice. The ability to swim was reported as being an important contribution to quality of life in the HPN consumer. Further research to explore documented CVC infections relative to swimming practice will assist in development of standard practice.
Effects of Ethanol Lock Therapy on Central Line Infections and Mechanical Problems in Children with Intestinal Failure
Jasmeet S. Mokha, MD, MPH, Connecticut Children’s Medical Center, Hartford, Connecticut
Although use of 70% ethanol lock therapy (ELT) has been shown to decrease the rate of catheter-related bloodstream infections (CRBSIs) in patients with intestinal failure and central venous catheters (CVCs), concerns have been raised about its association with higher rates of mechanical problems and CVC replacements (CVC-Rs). We sought to compare the rates of CRBSI, mechanical problems, and CVC-Rs in a cohort of pediatric patients with intestinal failure, with and without ELT (ELT+ and ELT-, respectively).
For this study, data was collected in a retrospective chart review from February 2007 to May 2014. Mann-Whitney and Wilcoxon signed-rank tests were used to compare nonparametric and paired data, respectively.
It was found that twenty-nine children had 9,033 catheter days (CDs). The ELT+ group (vs ELT-) had lower rate of infection and significantly fewer CVC-Rs due to infection, but significantly more mechanical events and related CVC-Rs with significantly shorter mean CVC survival. In thirteen children who had a pre-ELT and post-ELT period, ELT was associated with a decrease in the rate of CVC-Rs due to infection (0.36 vs 4.74/1000 CDs, P=.046) and an increase in the rate of CVC-Rs due to mechanical problems (5.05 vs 0/1000 CDs, P=.018).
The study concluded that while ELT+ is associated with a lower rate of CRBSIs and related CVC-Rs, it is also associated with higher rates of mechanical problems and related CVC-Rs. In addition to investigating the ideal concentration, duration, and timing of ELT to preserve the integrity of the CVC, alternatives to exclusively ethanol-based lock solutions should be developed.
Central Venous Catheter Life in Very Long-Term Home Parenteral Nutrition Patients
Marianne Opilla, RN, CNSC, Nutrishare, Inc., Elk Grove, California
Patients with debilitating gastrointestinal conditions may require HPN for a lifetime. HPN is infused through a central venous catheter (CVC). HPN complications associated with the CVC often result in removal and replacement of the device, which, over time, may lead to devastating loss of venous access sites. The CVC is considered a lifeline, and maintaining a trouble-free CVC is an important goal for HPN patients.
This study examined a group of very long-term HPN patients and reports their longest catheter life history.
The study used a retrospective chart review for CVC history completed for adult and pediatric HPN patients from one home infusion pharmacy. The data collection included age, gender, diagnosis for HPN, CVC type, and the longest number of days a CVC remained in place for each patient.
Patients on HPN for three years or more, and with a CVC in place for two years or more, were included in the cohort. A total of 103 patients were identified: 91 adults and 12 pediatric (<18 years). Females represented 60% and the average age was 49 years (range 9–90 years). The primary diagnosis was short bowel syndrome (70%), followed by chronic intestinal pseudo-obstruction (27%) and radiation enteritis (3%). The total HPN years for all patients was 1,995, with an average of about 19 years (range 4–39 years) on HPN.
The combined total CVC days for each patient’s longest lasting CVC were 291,744 days, with an average of 2,832 days/7.7 years for the entire group. Adults had 270,330 CVC days (range 832–7,490 days), averaging 2,970 days/8 years. Pediatric patients had 21,414 CVC days (range 813–4,686 days), averaging 1,784 days/4.88 years.
There were 81 tunneled CVCs (251,115 days). The majority of the tunneled CVCs were single lumen, open-ended, silicone devices (88%). There were 16 implanted infusion ports (31,236 days) and 6 peripherally inserted central catheters (9,393 days).
Patients were further divided into three groups based on CVC years. Twelve tunneled CVCs lasted 15+ years; 13 tunneled CVCs and 1 implanted infusion port lasted 10–15 years; and 27 tunneled CVCs, 6 implanted ports, and 1 peripherally inserted central catheter (PICC) lasted 5–10 years. The 25 tunneled CVCs lasting 10 years or greater were all single lumen, open-ended, silicone devices.
It was concluded from this study that in this cohort of adult and pediatric HPN patients, CVCs could be safely maintained for many years without serious complications that require removal and replacement. Tunneled CVCs, particularly the single lumen, open-ended, silicone design, last significantly longer than implanted ports and PICCs, and should strongly be considered for very long-term HPN patients. Pediatric CVC complication rates are generally reported as higher than adult’s, but in this group the pediatric patients experienced good CVC longevity. Through education on CVC care and clinical support, a long-term HPN patient can successfully preserve his or her lifeline for many years.
, May/June 2016