American Society for Parenteral and Enteral Nutrition Guidelines for the Selection and Care of Central Venous Access Devices for Adult Home Parenteral Nutrition Administration.

This document represents the American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines to describe best practices in the selection and care of central venous access devices (CVADs) for the infusion of home parenteral nutrition (HPN) admixtures in adult patients. The guidelines targeted adults >18 years of age in which the intervention or exposure had to include HPN that was administered via a CVAD. Case studies, non-English studies, or studies of CVAD no longer available in the United States were excluded.

Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care.

Background: Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States.

A.S.P.E.N. Standards for Nutrition Support: Home and Alternate Site Care.

The American Society for Parenteral and Enteral Nutrition (A.S.P.

The effects of needleless connectors on catheter-related thrombotic occlusions.

Needleless connectors have been introduced into clinical practice to prevent accidental needlestick injuries and associated bloodborne infections. Needleless connectors include the split-septum devices and the mechanical valves that are classified as neutral-, negative-, and positive-displacement types on the basis of their internal membrane or valve function. Some studies have reported that mechanical valves, especially positive-displacement valves, may decrease thrombotic catheter occlusions based on their valve function that prevents blood reflux into the intravascular catheter.

The effects of needleless connectors on catheter-related bloodstream infections.

Needleless connectors, including the standard split septum and the luer-activated mechanical valve connectors, have been introduced into clinical practice to eliminate the risk of needlestick injuries by avoiding the use of needles when accessing the intravascular catheters. Negative and positive displacement mechanical valves have been associated with increased rates of catheter-related bloodstream infections as compared with split septum connectors. Based on available data, split septum connectors should be preferentially used instead of mechanical valves.

Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure.

Background: Central venous access device (CVAD) infections are a major complication in pediatric patients receiving long-term parenteral nutrition (PN) and are particularly prevalent in patients with intestinal failure. This study evaluated the outcomes of outpatient ethanol-lock therapy (ELT) for the prevention of CVAD infections in children with intestinal failure.

Methods: In this retrospective analysis, the primary outcome measure was the rate of bloodstream infection (BSI) due to CVAD infections per 1,000 catheter days, and secondary measures included type of organisms cultured and complications of ELT.

Pediatric short-bowel syndrome: the cost of comprehensive care.

Background: Little information is available about the financial charges incurred by patients with short-bowel syndrome (SBS). This is particularly true for pediatric SBS patients who receive some of the most complex medical care.

Objectives: The aims of this study were to determine the total cost of care for these patients and to analyze their utilization of home and hospital-based health care services.