Percutaneous vs. totally implantable catheters in home parenteral nutrition

The technique of the implementation of Home Parenteral Nutrition (HPN) is improving continuously so carrying minimum risk of technical complications and supplying maximum comfort for the patient. For example the HPN benefits of the recent availability of Ethil-Vinil-Acetate (EVA) bags that permit the contemporary administration of all nutrients, lipids included, and of infusion pumps which are lighter, safer and more versatile and which have rechargeable batteries. Some new types of completely implantable catheters with a subcutaneous reservoir present a better rationale compared with complications and with patient's compliance in respect of traditional percutaneous catheters used in HPN. We wanted to verify these presuppositions in a retrospective study with a completely implantable catheter, Port-A-Cath (PAC) Pharmacia, with a group of six patients already under HPN for a period of 901 patient-days with a percutaneous catheter. We compared the two methods of treatment after 1114 patient-days with the PAC. Concerning complications, we have three catheter related sepsis (3.3 1000 days) with percutaneous catheter and 1 sepsis (0.9 1000 days) with the PAC. We also had one catheter obstruction in a patient with the PAC implanted in the Inferior Vena Cava. All the patients accepted the new technique and even if they did not have the same motivation, all of them particularly appreciated the possibility of the avoidance of any external device. Our experience leads us to report that the Port-A-Cath system may be useful in long-term parenteral nutrition but other research is needed to confirm its rationale.