C. Martínez

Prevención e incidencia de oclusión del catéter y trombosis venosa en pacientes adultos con nutrición parenteral domiciliaria (NPD)

In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial. Objectives: To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country. Methods: Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008. Results: 49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/10 3 and 0.115/10 3 HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism. Conclussion: The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and Resumen Hasta el momento actual no hay ninguna recomendacion basada en la evidencia sobre la sistematica a seguir de cara a mantener la permeabilidad de los accesos venosos ni prevenir la trombosis venosa en pacientes en programa de NPD. La utilizacion de heparina no esta exenta de riesgos y de complicaciones a largo plazo. El uso de anticoagulantes tambien es discutido. Objetivos: Conocer la practica habitual, en nuestro pais, del mantenimiento de los cateteres venosos centrales para NPD, la incidencia de oclusion de los mismos y de trombosis venosa asociada. Metodos: estudio retrospectivo de los pacientes mayores de 18 anos en activo en programa de NPD hasta noviembre de 2008, registrados por el grupo NADYASENPE. Resultados: Se incluyeron un total de 49 pacientes (16 hombres y 33 mujeres) pertenecientes a 6 hospitales, con una media de edad de 52,1 ± 13,9 anos y una duracion de la NPD de 57,4 ± 73,3 meses, con una media de 5,8 ± 1,8 dias de NP a la semana. Las patologias mas frecuentes fueron enteritis radica, alteraciones de la motilidad intestinal e isquemia mesenterica, (20,4% de pacientes cada una) y neoplasia activa (16,3%). Las principales indicaciones de la NPD fueron el sindrome de intestino corto (49,0%) y obstruccion intestinal (28,6%). Los principales factores predisponentes de trombosis venosa aparte de la neoplasia fueron: diatesis trombotica, enfermedad tromboembolica, y reposo en cama con un 6,1% cada una de ellas. El 77,6% de los pacientes recibia la NPD a traves de un cateter tunelizado, y el resto a traves de un reservorio implantado. Para el mantenimiento de la permeabilidad del cateter en el 28,6% de pacientes se usaba suero fisiologico y en el 69,4% heparina en distintas concentraciones retirandose esta del cateter previa la administracion de la NPT en el 63,3% de los casos.UNLABELLED In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial. OBJECTIVES To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country. METHODS Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008. RESULTS 49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/10³ and 0.115/10³ HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism. CONCLUSION [corrected] The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and catheter related venous thrombosis. In conclusion, it would be necessary to standardize practice.

Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España en el año 2008

Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes finished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes finished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any significant change in the characteristics of the patients other than longer duration of the episodes.