PD1066 - SCANNING ELECTRON MICROSCOPY AND FEMORAL CENTRAL VENOUS ACCESS TO IMPROVEFEASIBILITY OF PARENTERAL NUTRITION

PD1066

SCANNING ELECTRON MICROSCOPY AND FEMORAL CENTRAL VENOUS ACCESS TO IMPROVE

FEASIBILITY OF PARENTERAL NUTRITION

 

F. Mario^1,* on behalf of NUTRIMEDIC, M. Ocaña¹ on behalf of NUTRIMEDIC, L. Guerrero¹ on behalf of NUTRIMEDIC, M. Harkin¹ on behalf of NUTRIMEDIC on behalf of NUTRIMEDIC

¹NUTRITIONAL SUPPORT, NUTRIMEDIC, CALLAO, Peru

 

Rationale: Femoral access is considered inappropiate because of likely infection. In 2010, 11 tunneled femoral CVC with inner tip above renal veins was reported  for parenteral nutrition for 63.72±46.4 days, range: 13 – 165 days. It is considered if superior vena cava access is not feasible. It has been reported that taurolidine (Taurolock™) neutralizes bacteria, fungi and biofilms in vivo  in both TCVC and PICC with E/M, when Maki´s technique denies invading  microorganisms and biofilms.

We wish to report E/M photos and X rays as evidence that:

Taurolidine destroys biofilms and bacteria/fungi even after the CVC has been withdrawn and it is injected right away.

TCVC can be used safely, above renal veins, up to the liver and its draining veins. So taurolidine could improve the technique when inferior vena cava has to be used, as the only choice.

Lack of Vancomycin-lock effect to destroy CVC bacteria and biofilms . (Photos 7,8)

Methods: 11 CVC were studied: 10/11 with taurolidine-lock in vitro and 1 in vivo home-vancomycin-lock for 7 days. Catheters were studied with E/M.

Femoral TCVC (One-lumen Silicone Broviac) in 2 patients: 1 adult and 1 infant.

Results: 10 Catheters studied in vitro with taurolidine were all positive for bacteria and/or fungi and biofilms. Microorganisms and biofilms were destroyed.(Photos 1-4)

Femoral TCVC stayed 46 and 60 days in an adult and an infant respectively, the inner tip is in the vicinity of posterior hepatic veins, and were withdrawn when they were not needed any more. (Photos 5-6)

The infant´s 7-day vancomycin-lock CVC was completely invaded by bacteria and biofilm and Makis´s culture was negative, though.(Photos 7-8 )

Image:

 

Conclusion: 1) Taurolidine is effective to destroy biofilms and microorganisms invading catheters.

2) Femoral tunneled catheters are safe if they are placed between renal veins and hepatic veins.

3) Vancomycin-lock is not safe.

Disclosure of Interest: None declared