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Journal of Parenteral and Enteral Nutrition
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Evidence-Based Practice in the Management of Vascular Access Devices for Home Parenteral Nutrition Therapy

Marcia Ryder, PhD, MS, RN

From Research and Consulting, Healthcare-acquired Infections/Vascular Access, San Mateo, California

Correspondence: Marcia A. Ryder, RN, Research and Consulting, Healthcare-acquired Infections/Vascular Access, 1504 Forge Road, San Mateo, CA 94402. Electronic mail may be sent to ryder1234{at}aol.com.

Catheter-related bloodstream infection and catheter occlusion are potential significant complications of parenteral nutrition therapy. The increased incidence and associated morbidity, mortality, increased costs, and quality-of-life issues experienced with these adverse events necessitate specialized management of vascular access devices. The host coagulation response to biomaterials and the associated development of biofilm on vascular devices are complex phenomena. Multiple interventions are required to prevent access of bacteria to both intraluminal and extraluminal catheter surfaces, and the occurrence of catheter occlusion. The discovery of the biofilm form of microbial life and the associated recalcitrance of biofilm bacteria to antimicrobials has provided insight into the failure of current prevention, diagnostic, and treatment protocols. Critical interventions are presented correlating current evidence with new discoveries in pathogenesis.

Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 1 suppl, S82-S93 (2006)
DOI: 10.1177/01486071060300S1S82
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