Complications of Long-Term Home Parenteral Nutrition: Catheter-Related Bloodstream Infections

Abstract

Introduction: Home parenteral nutrition (HPN) is life-saving for intestinal failure but carries risks of catheter-related bloodstream infection (CRBSI) and liver disease. Preventive bundle effectiveness in real-world settings needs quantification.
Methods: Systematic review of 20 cohort studies (n=3,104 HPN patients) with follow-up ≥12 months. Intervention: standardized catheter care bundles (taurolidine lock, ethanol lock, chlorhexidine dressing, nurse-led education). Outcome: CRBSI rate per 1,000 catheter-days. Secondary: catheter salvage rate, mortality from sepsis.
Results: Baseline CRBSI rate was 2.8/1,000 days (range 1.2–5.4). Taurolidine lock reduced CRBSI to 0.9/1,000 days (RR 0.32, p<0.001). Ethanol lock had similar efficacy but caused catheter damage (cracking 4% vs 0%). Chlorhexidine dressings alone reduced CRBSI by 41% (RR 0.59). Nurse-led education lowered CRBSI by 52%. Bundle adherence >80% achieved rates <1.0/1,000 days. Catheter salvage succeeded in 68% of CRBSI episodes with antibiotic lock therapy.
Discussion: Preventive bundles dramatically reduce CRBSI but require multidisciplinary teams. Taurolidine is preferred over ethanol.
Conclusion: Taurolidine catheter lock combined with nurse-led education reduces long-term HPN CRBSI to <1 per 1,000 catheter-days.