Table 5.
Disease-related complications of short bowel syndrome/intestinal failure
| Complication | Pathophysiology | Management | Prevention |
|---|---|---|---|
| Catheter-related infections | • Local (catheter exit site, port pocket, subcutaneous catheter tunnel), or systemic infection | • Preserve the catheter whenever possible | • Aseptic technique during placement and dressing changes |
| • Most infections are bacterial in origin, but they can also be caused by fungi | • Remove in case of tunnel infections, port abscesses, septic shock, complicated infections (e.g., endocarditis), and blood stream fungal or virulent bacterial infection | • Tunneled single-lumen catheters are advocated if possible | |
| • Reinsertion of a new device should be postponed after systemic antibiotic therapy course is completed, as well as negative blood samples | • Proper catheter care and monitoring for signs of infection | ||
| • No evidence of using in-line filters, routine catheters’ replacement, antibiotic prophylaxis, heparin or 70% ethanol lock | |||
| • Catheter locking with taurolidine appears to reduce catheter-related infections | |||
| Catheter-related thrombosis | • Procoagulant conditions | • Anticoagulation (low molecular weight heparin, followed by vitamin K antagonists for 3–6 months) | • Ultrasound-guided catheter placement |
| • Diagnosed with computed tomography with angiography or with ultrasonography | • Preserve the catheter whenever possible | • Placement of the tip at the superior cavoatrial junction | |
| • Remove in case of infection, occlusion, contraindication to anticoagulation or symptom persistence despite appropriate therapy | • Thromboprophylaxis with heparin/warfarin is not recommended | ||
| Catheter-related occlusion | • Usually the result of catheter thrombosis | • Flush the catheter with saline to restore patency | • Flush the catheter with saline after PN infusion |
| • HPN formula components (lipids and calcium-phosphate precipitates) | • Fibrinolytic agents (alteplase, urokinase) for thrombotic occlusion | • Infusion pumps may reduce this complication |
EN, enteral nutrition; PN, parenteral nutrition; PUFA, poly-unsaturated fatty acid.
*Especially in patients with colon in continuity.