Digestive Disease Interventions 2018; 02(01): 079-084
DOI: 10.1055/s-0038-1651484
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Parenteral Nutrition in Interventional Radiology: Consideration and Management of the Patient

Eunice Moon
1   Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, Ohio
Baljendra Kapoor
1   Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, Ohio
Weiping Wang
2   Department of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, Florida
› Author Affiliations
Further Information

Publication History

16 February 2018

02 April 2018

Publication Date:
11 May 2018 (online)


The approach for patients on parenteral nutrition is typically multidisciplinary. Catheters for parenteral nutrition are primarily placed by interventional radiologists under image guidance. Therefore, adequate knowledge of different catheters, including their indications and complications, as well as management of the complications is exceptionally important for interventional radiologists as well as the referring service. In this review, we discuss different aspects of parenteral nutrition, including infectious complications and the strategy for their prevention and management.

  • References

  • 1 Worthington P, Balint J, Bechtold M. , et al. When is parenteral nutrition appropriate?. JPEN J Parenter Enteral Nutr 2017; 41 (03) 324-377
  • 2 Pironi L, Arends J, Bozzetti F. , et al; Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35 (02) 247-307
  • 3 McClave SA, Taylor BE, Martindale RG. , et al; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016; 40 (02) 159-211
  • 4 Lee S, Park HJ, Yoon J. , et al. Reversal of intestinal failure-associated liver disease by switching from a combination lipid emulsion containing fish oil to fish oil monotherapy. JPEN J Parenter Enteral Nutr 2016; 40 (03) 437-440
  • 5 El Kasmi KC, Anderson AL, Devereaux MW. , et al. Phytosterols promote liver injury and Kupffer cell activation in parenteral nutrition-associated liver disease. Sci Transl Med 2013; 5 (206) 206ra137
  • 6 Howard L. Home parenteral nutrition: survival, cost, and quality of life. Gastroenterology 2006; 130 (02) (Suppl. 01) S52-S59
  • 7 Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care 2007; 11 (05) R114
  • 8 Cheung NW, Napier B, Zaccaria C, Fletcher JP. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care 2005; 28 (10) 2367-2371
  • 9 Reimund JM, Duclos B, Arondel Y, Baumann R. Persistent inflammation and immune activation contribute to cholestasis in patients receiving home parenteral nutrition. Nutrition 2001; 17 (04) 300-304
  • 10 Hise M, Compher C, Brown J. Inflammatory mediators and home parenteral nutrition. Nutr Clin Pract 2008; 23 (01) 42-48
  • 11 Salvino R, Ghanta R, Seidner DL, Mascha E, Xu Y, Steiger E. Liver failure is uncommon in adults receiving long-term parenteral nutrition. JPEN J Parenter Enteral Nutr 2006; 30 (03) 202-208
  • 12 Staun M, Pironi L, Bozzetti F. , et al; ESPEN. ESPEN Guidelines on Parenteral Nutrition: home parenteral nutrition (HPN) in adult patients. Clin Nutr 2009; 28 (04) 467-479
  • 13 Kumar JA, Teckman JH. Controversies in the mechanism of total parenteral nutrition induced pathology. Children (Basel) 2015; 2 (03) 358-370
  • 14 Sahu S, Lata I, Sachan S, Singh RK. Emergency central venous catheterization revisited. J Emerg Trauma Shock 2009; 2 (03) 218-219
  • 15 O'Grady NP, Alexander M, Burns LA. , et al; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52 (09) e162-e193
  • 16 McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003; 348 (12) 1123-1133
  • 17 Elfassy S, Kassam Z, Amin F, Khan KJ, Haider S, Armstrong D. Epidemiology and risk factors for bloodstream infections in a home parenteral nutrition program. JPEN J Parenter Enteral Nutr 2015; 39 (02) 147-153
  • 18 Tokars JI, Cookson ST, McArthur MA, Boyer CL, McGeer AJ, Jarvis WR. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy. Ann Intern Med 1999; 131 (05) 340-347
  • 19 Ishizuka M, Nagata H, Takagi K, Kubota K. Total parenteral nutrition is a major risk factor for central venous catheter-related bloodstream infection in colorectal cancer patients receiving postoperative chemotherapy. Eur Surg Res 2008; 41 (04) 341-345
  • 20 Shenep MA, Tanner MR, Sun Y. , et al. Catheter-related complications in children with cancer receiving parenteral nutrition: change in risk is moderated by catheter type. JPEN J Parenter Enteral Nutr 2017; 41 (06) 1063-1071
  • 21 Santarpia L, Buonomo A, Pagano MC. , et al. Central venous catheter related bloodstream infections in adult patients on home parenteral nutrition: Prevalence, predictive factors, therapeutic outcome. Clin Nutr 2016; 35 (06) 1394-1398
  • 22 Grant JD, Stevens SM, Woller SC. , et al. Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb Haemost 2012; 108 (06) 1097-1108
  • 23 Norris LB, Kablaoui F, Brilhart MK, Bookstaver PB. Systematic review of antimicrobial lock therapy for prevention of central-line-associated bloodstream infections in adult and pediatric cancer patients. Int J Antimicrob Agents 2017; 50 (03) 308-317
  • 24 Schoot RA, van Ommen CH, Stijnen T. , et al. Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: A randomised controlled multi-centre trial. Eur J Cancer 2015; 51 (14) 2031-2038
  • 25 Goossens GA. Flushing and locking of venous catheters: available evidence and evidence deficit. Nurs Res Pract 2015; DOI: 10.1155/2015/985686.
  • 26 Ławiński M, Majewska K, Gradowski Ł, Fołtyn I, Singer P. A comparison of two methods of treatment for catheter-related bloodstream infections in patients on home parenteral nutrition. Clin Nutr 2015; 34 (05) 918-922
  • 27 Davidson JB, Edakkanambeth Varayil J, Okano A. , et al. Prevention of subsequent catheter-related bloodstream infection using catheter locks in high-risk patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 2017; 41 (04) 685-690
  • 28 Hemmelgarn BR, Moist LM, Lok CE. , et al; Prevention of Dialysis Catheter Lumen Occlusion with rt-PA versus Heparin Study Group. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N Engl J Med 2011; 364 (04) 303-312
  • 29 Malec LM, Cooper J, Rudolph J, Michaels MG, Ragni MV. Prophylactic rtPA in the prevention of line-associated thrombosis and infection in short bowel syndrome. J Pediatr Gastroenterol Nutr 2017; ( e-pub ahead of print) DOI: 10.1097/MPG.0000000000001836.
  • 30 Oliveira C, Nasr A, Brindle M, Wales PW. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis. Pediatrics 2012; 129 (02) 318-329
  • 31 John BK, Khan MA, Speerhas R. , et al. Ethanol lock therapy in reducing catheter-related bloodstream infections in adult home parenteral nutrition patients: results of a retrospective study. JPEN J Parenter Enteral Nutr 2012; 36 (05) 603-610
  • 32 Mermel LA, Alang N. Adverse effects associated with ethanol catheter lock solutions: a systematic review. J Antimicrob Chemother 2014; 69 (10) 2611-2619
  • 33 Miller LM, Clark E, Dipchand C. , et al; Canadian Society of Nephrology Vascular Access Work Group. Hemodialysis tunneled catheter-related infections. Can J Kidney Health Dis 2016; 3: 2054358116669129
  • 34 Aslam S, Vaida F, Ritter M, Mehta RL. Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia. J Am Soc Nephrol 2014; 25 (12) 2927-2941
  • 35 Barco S, Heuschen CBBCM, Salman B. , et al. Home parenteral nutrition-associated thromboembolic and bleeding events: results of a cohort study of 236 individuals. J Thromb Haemost 2016; 14 (07) 1364-1373
  • 36 Steiger E. Obtaining and maintaining vascular access in the home parenteral nutrition patient. JPEN J Parenter Enteral Nutr 2002; 26 (5, Suppl): S17-S20
  • 37 Luciani A, Clement O, Halimi P. , et al. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 2001; 220 (03) 655-660
  • 38 DeChicco R, Seidner DL, Brun C, Steiger E, Stafford J, Lopez R. Tip position of long-term central venous access devices used for parenteral nutrition. JPEN J Parenter Enteral Nutr 2007; 31 (05) 382-387
  • 39 Akl EA, Kamath G, Yosuico V. , et al. Thromboprophylaxis for patients with cancer and central venous catheters: a systematic review and a meta-analysis. Cancer 2008; 112 (11) 2483-2492
  • 40 Kovacs MJ, Kahn SR, Rodger M. , et al. A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study). J Thromb Haemost 2007; 5 (08) 1650-1653
  • 41 Cimochowski GE, Worley E, Rutherford WE, Sartain J, Blondin J, Harter H. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron 1990; 54 (02) 154-161
  • 42 Schillinger F, Schillinger D, Montagnac R, Milcent T. Post-catheterization venous stenosis in hemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses [in French]. Nephrologie 1992; 13 (03) 127-133
  • 43 Schillinger F, Schillinger D, Montagnac R, Milcent T. Central venous stenosis in hemodialysis: comparative angiographic study of subclavian and internal jugular access [in French]. Nephrologie 1994; 15 (02) 129-131
  • 44 Zaleski GX, Funaki B, Lorenz JM. , et al. Experience with tunneled femoral hemodialysis catheters. AJR Am J Roentgenol 1999; 172 (02) 493-496
  • 45 Maya ID, Allon M. Outcomes of tunneled femoral hemodialysis catheters: comparison with internal jugular vein catheters. Kidney Int 2005; 68 (06) 2886-2889
  • 46 Parienti JJ, Thirion M, Mégarbane B. , et al; Members of the Cathedia Study Group. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 2008; 299 (20) 2413-2422
  • 47 Ballard DH, Samra NS, Gifford KM, Roller R, Wolfe BM, Owings JT. Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis. Emerg Radiol 2016; 23 (03) 269-273
  • 48 Power A, Singh S, Ashby D. , et al. Translumbar central venous catheters for long-term haemodialysis. Nephrol Dial Transplant 2010; 25 (05) 1588-1595
  • 49 Food and Drug Administration. Precautions Necessary with Central Venous Catheters. FDA Task Force. FDA Drug Bulletin; 1989: 15-16
  • 50 Ramos GE, Bolgiani AN, Patiño O. , et al. Catheter infection risk related to the distance between insertion site and burned area. J Burn Care Rehabil 2002; 23 (04) 266-271
  • 51 Miller DL, O'Grady NP. ; Society of Interventional Radiology. Guidelines for the prevention of intravascular catheter-related infections: recommendations relevant to interventional radiology for venous catheter placement and maintenance. J Vasc Interv Radiol 2012; 23 (08) 997-1007