230 PATIENT YEARS OF EXPERIENCE WITH HOME LONG-TERM PARENTERAL-NUTRITION IN CHILDHOOD - NATURAL-HISTORY AND LIFE OF CENTRAL VENOUS CATHETERS

The records of 27 pediatric patients who required parenteral nutrition (PN) for 5 to 14.5 years (mean +/- SD, 8.5 +/- 3.8) were analyzed to determine the frequency of complications with their central venous cat heters (CVC). This represents a 230 patient-year experience. Patients with short bower syndrome and chronic intestinal pseudoobstruction syn drome (CIPS) accounted for all but two of the patients. Unsuccessful m edical management of the exit site or CVC infection was responsible fo r removal of 62% of the 123 CVCs. Ninety-five episodes of line infecti on occurred in 24 patients. Fifty (52%) were successfully treated with out catheter removal. The organisms responsible for catheter removal w ere fungal (14), mycobacterium species (5), gram-positive cocci (22), or gramnegative bacilli (19). The CVCs were infected an average of onc e every 884 days. The life of the second CVC (23.5 +/- 17.9 months) wa s significantly longer than that of the first (P < .05). Clotting of t he CVC with unsuccessful lysis of the clot was responsible for removal of 24%, and breakage or unsuccessful repair was responsible for 14%. in no patient were all possible venous sites for CVC placement exhaust ed. Patients with CIPS had substantially fewer catheter complications (P < .05) than did those with Short bowel syndrome. In conclusion, CVC s can ''survive'' without major complications for more than a decade. Numerous factors contribute to the increased rate of CVC survival over time, including improvement in PN self-care with greater experience, improvement in teaching, regular follow-up of patients, better managem ent of infection, and better ability to treat CVC thrombosis or breaka ge. Copyright (C) 1994 by W.B. Saunders Company