ASPEN Guidelines for Central Venous Access Devices in Home Parenteral Nutrition

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary purpose of developing key questions in the clinical guideline?

To determine the target population for the study

To address the specific outcomes that would be investigated (correct)

To develop a comprehensive literature search strategy

To establish a time frame for the literature search

What is the total number of citations yielded by the literature search?

1000

400

564 (correct)

750

What is the primary criterion for including studies in the guideline?

Randomized clinical trial or meta-analysis only

Conducted in adults (>18 years) and included HPN (correct)

Published in the last 5 years

All of the above

What is the primary reason for excluding studies from the guideline?

Did not meet inclusion criteria Signup and view all the answers

What is the primary purpose of using flush solutions in HPN?

To maintain catheter patency Signup and view all the answers

What is the primary advantage of using tunneled catheters in HPN?

Long-term durability Signup and view all the answers

What is the primary complication associated with PICCs in HPN?

Deep vein thrombosis Signup and view all the answers

What is the primary reason for re-insertion of the CVAD after removal for CLABSI?

Once the infection is resolved Signup and view all the answers

What is the primary limitation of using PICCs in HPN?

Limited dwell time Signup and view all the answers

What is the primary consideration for selecting a CVAD for HPN?

All of the above Signup and view all the answers

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 Signup and view all the answers

Which type of CVAD is most suitable for extended periods of parenteral nutrition (PN)?

Tunnelled CVADs Signup and view all the answers

What is the major limitation of using antibiotics to treat central line-associated bloodstream infections (CLABSI)?

Antibiotics may not adequately infiltrate the biofilm Signup and view all the answers

What is the primary advantage of using ethanol in treating CLABSI?

It is bactericidal as well as fungicidal and can penetrate the biofilm Signup and view all the answers

What is the primary goal of home parenteral nutrition (HPN) care?

All of the above Signup and view all the answers

What is the major benefit of salvaging a long-term catheter?

It preserves the remaining viable veins Signup and view all the answers

Which type of CVAD is associated with the lowest risk of central line-associated bloodstream infection (CLABSI)?

Implanted ports Signup and view all the answers

Why is prophylactic antibiotic lock solution recommended only in specific patients with long-term CVADs?

Both a and b Signup and view all the answers

What is the primary role of clinicians in HPN care?

To be knowledgeable about the best CVAD options and treatment options Signup and view all the answers

What is a major risk factor for central line-associated bloodstream infections (CLABSI) in pediatric patients with cancer?

Prolonged neutropenia Signup and view all the answers

What was the minimum age requirement for adults included in the targeted population for the ASPEN clinical guidelines?

18 years Signup and view all the answers

What was the total number of abstract citations scanned for relevance in the study?

564 Signup and view all the answers

How many of the 564 citations addressed at least one of the 6 guideline-related questions?

13 Signup and view all the answers

What was the criteria used to adjust the evidence grade based on assessment of the quality of study design and execution?

GRADE criteria Signup and view all the answers

What was the reason for excluding case studies from the study?

Not relevant to the topic Signup and view all the answers

How many studies were found that compared best solutions for routine flushing of lumens?

None Signup and view all the answers

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 Signup and view all the answers

Who approved the clinical guidelines?

ASPEN Board of Directors Signup and view all the answers

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.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

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.