LITRE'S Catheter Occlusion Survey

01/10/2010

One of LITRE s projects in 2003 was a survey to access the prevalence of line blockages in Home Parenteral Nutrition (HPN) catheters and the methods used to try to prevent and resolve the problem. Below is the abstract of the results which have caused a lot of interest and hopefully this project will be the basis of further work. Thank you to everyone who helped by completing the questionnaire.
One of LITRE s projects in 2003 was a survey to access the prevalence of line blockages in Home Parenteral Nutrition (HPN) catheters and the methods used to try to prevent and resolve the problem. Below is the abstract of the results which have caused a lot of interest and hopefully this project will be the basis of further work. Thank you to everyone who helped by completing the questionnaire.

Blockage of a HPN catheter is a common problem reported to the LITRE committee. The aim of the survey was to determine if catheter occlusio is more common in HPN patients infusing lipid, flushing the catheter with saline (rather than heparin), or having no heparin in the parenteral feeding bag.

A questionnaire was sent to all PINNT members having parenteral nutrition and to the two Intestinal Failure Units at Hope Hospital and St Mark's. The questions were about line blockage, lipid infusion, line flushing, the addition of heparin to the PN bag, and methods to treat line blockage.

Of the 360 questionnaires, 103 (29%) were returned. Line occlusion was reported in forty-five (44%).

No OcclusionOcclusionLipid3027Separate lipid911No lipid197*The table shows the effect of Lipid on line occlusion*p=0.06

Line occlusion occured in 5, 13 and 24 patients using heparin, using saline or a saline then heparin flush after the PN infusion respectively, compared with 12, 14 and 25 without. Of thirty-two who had heparin added to their PN bag line occlusion occurred in ten compared with thirty-three of sixty-five (51% having no heparin in the bag (p=0.05). Of those forty-five who had a blockage, thirty-five (78%) took no precautions to prevent blockage though six out of ten used an alcohol flush.

In conclusion, occlusion of an HPN catheter is common and patients who do not infuse lipid may have fewer line occlusions than those who infuse it separately or in an all-in-one bag. Patients who have heparin added to their PN bag may also have fewer line occlusions. Randomised prospective controlled studies are needed to further investigate the role of lipid infusions, non-heparin flushing of the catheter and the addition of heparin to PN bags.



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