Removal of very long-term central venous access devices
Abstract:
Background: Home parenteral nutrition (HPN) is life-saving treatment for chronic intestinal failure (CIF), a rare disease. Central venous access devices (CVADs) for HPN are vitals and are maintained in situ as long as possible. However, removal of very long-term CVADs may be difficult and associated with complications causing venous access loss. An international cross-sectional survey was carried out to evaluate clinicians’ experiences in the management of very long-term CVADs (tunneled/Port catheters >10 years; Peripherally-Inserted Central Catheters-PICCs >2 years) and their opinions on elective replacement of these devices.
Methods: The HPN/CIF centers within the directory of the CIF database of the European Society for Clinical Nutrition and Metabolism were invited to answer to a structured questionnaire.
Results: Thirty-five centers participated. CVADs in place >10 years included 7.1% of tunneled and 3.6% of Port; 7.1% of PICCs were in place >2 years. Complications when removing long-term CVADs were encountered by 44.1% of centers for tunneled, 18.7% for Port, 9.0% for PICCs. Elective replacement of functioning long-term CVADs was recommended by 14.3% of centers for tunneled, 5.9% for Port, 30.3% for PICCs. Around one-half of centers disagreed with elective replacement of functioning long-term tunneled and Port; one-third disagreed with elective PICC replacement.
Conclusions: Functioning very long-term CVADs occur rarely in a rare disease. A discrepancy was observed between the high percentage of centers that encountered complications when removing such CVADs compared with the low percentage of those that agreed with their elective replacement. These data can inform the development of protocols for the management of functioning long-term CVADs.
Reference:
Pironi L, Joly F, Cuerda C, Jeppesen PB, Lamprecht G, Mundi MS, Szczepanek K, Van Gossum A, Vanuytsel T, Wanten G, Zarpellon M, Lal S; Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. Very long-term central venous access device for home parenteral nutrition in adults: A center-based cross-sectional survey. Clin Nutr ESPEN. 2025 Jun 30:S2405-4577(25)00399-7. doi: 10.1016/j.clnesp.2025.06.052. Epub ahead of print. PMID: 40602603.