28 Questions
What is the primary purpose of developing key questions in the clinical guideline?
To address the specific outcomes that would be investigated
What is the total number of citations yielded by the literature search?
564
What is the primary criterion for including studies in the guideline?
Conducted in adults (>18 years) and included HPN
What is the primary reason for excluding studies from the guideline?
Did not meet inclusion criteria
What is the primary purpose of using flush solutions in HPN?
To maintain catheter patency
What is the primary advantage of using tunneled catheters in HPN?
Long-term durability
What is the primary complication associated with PICCs in HPN?
Deep vein thrombosis
What is the primary reason for re-insertion of the CVAD after removal for CLABSI?
Once the infection is resolved
What is the primary limitation of using PICCs in HPN?
Limited dwell time
What is the primary consideration for selecting a CVAD for HPN?
All of the above
What is the primary purpose of the cuff in tunnelled central venous access devices (CVADs)?
To prevent the movement of microbes and reduce the likelihood of device displacement
Which type of CVAD is most suitable for extended periods of parenteral nutrition (PN)?
Tunnelled CVADs
What is the major limitation of using antibiotics to treat central line-associated bloodstream infections (CLABSI)?
Antibiotics may not adequately infiltrate the biofilm
What is the primary advantage of using ethanol in treating CLABSI?
It is bactericidal as well as fungicidal and can penetrate the biofilm
What is the primary goal of home parenteral nutrition (HPN) care?
All of the above
What is the major benefit of salvaging a long-term catheter?
It preserves the remaining viable veins
Which type of CVAD is associated with the lowest risk of central line-associated bloodstream infection (CLABSI)?
Implanted ports
Why is prophylactic antibiotic lock solution recommended only in specific patients with long-term CVADs?
Both a and b
What is the primary role of clinicians in HPN care?
To be knowledgeable about the best CVAD options and treatment options
What is a major risk factor for central line-associated bloodstream infections (CLABSI) in pediatric patients with cancer?
Prolonged neutropenia
What was the minimum age requirement for adults included in the targeted population for the ASPEN clinical guidelines?
18 years
What was the total number of abstract citations scanned for relevance in the study?
564
How many of the 564 citations addressed at least one of the 6 guideline-related questions?
13
What was the criteria used to adjust the evidence grade based on assessment of the quality of study design and execution?
GRADE criteria
What was the reason for excluding case studies from the study?
Not relevant to the topic
How many studies were found that compared best solutions for routine flushing of lumens?
None
What was the outcome of the GRADE process used to develop key questions and plan data acquisition and conflation for these guidelines?
Development of key questions and plan data acquisition
Who approved the clinical guidelines?
ASPEN Board of Directors
Study Notes
ASPEN Clinical Guidelines for Central Venous Access Devices (CVADs)
- The American Society for Parenteral and Enteral Nutrition (ASPEN) has developed clinical guidelines for the selection and care of CVADs for adult patients receiving home parenteral nutrition (HPN) admixtures.
Inclusion and Exclusion Criteria
- The guidelines targeted adults >18 years of age, with HPN administered via a CVAD, and excluded case studies, non-English studies, and studies of CVADs no longer available in the United States.
Literature Search and Study Selection
- A total of 564 abstract citations were scanned for relevance, with 13 studies addressing at least one of the 6 guideline-related questions.
- No studies were found that compared best solutions for routine flushing of lumens or for maintaining catheters in situ while treating CVAD mechanical or infectious complications.
Recommendations for CVAD Selection and Care
- The type of CVAD (tunneled, implanted, or PICC) influences CLABSI rates, and tunneled CVADs are recommended for adult patients anticipated to require long-term daily PN infusions.
- The composition and number of lumens of CVADs can minimize infectious or mechanical complications, but the evidence is limited and based on expert opinion.
- No studies were found that compared the best solutions for routine flushing of lumens or for maintaining catheters in situ while treating CVAD mechanical or infectious complications.
Complications of CVADs
- The most common complications of HPN therapy are CVAD mechanical complications and central line-associated blood stream infections (CLABSIs).
- CLABSIs are a major concern, and the use of ethanol locks has been proposed as a treatment option due to its ability to penetrate the biofilm and its bactericidal and fungicidal properties.
Goals of HPN Care
- The goals of HPN care are to teach patients to become independent in their care, keep patients in their home, and maintain their quality of life by avoiding hospitalizations or unnecessary resource utilization needed to treat CVAD complications.
Importance of CVAD Selection and Care
- The selection and care of CVADs are critical to minimizing the risk of mechanical or infectious complications and achieving the goals of HPN care.
- Clinicians must be knowledgeable about the best CVADs on the market and the most effective treatment options to minimize the risk of complications.
Best practices for selecting and caring for central venous access devices for infusing home parenteral nutrition admixtures in adult patients. Guidelines target adults over 18 years old.
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