Achieving and maintaining venous access for home parenteral nutrition.

PURPOSE OF REVIEW: Once chronic intestinal failure is established and home parenteral nutrition has become necessary, the patient's life is literally dependent on secure long-term central venous access, other than in the small group in whom intestinal transplantation is both appropriate and available. Means to preserve venous access are therefore crucial.

RECENT FINDINGS: Recent papers have explored the nature of the complications that occur (in epidemiological, clinical and microbiological contexts), and have considered management strategies to prevent problems and generally to reduce morbidity. Interesting new data on patient attitudes to domiciliary care and the effects of these on outcomes are also presented.

SUMMARY: Home parenteral nutrition has a relatively high technical complication rate, but remains a safer option than intestinal transplantation. Meticulous attention to aseptic techniques, and patient-centred training and support can nevertheless improve outcomes and prolong the useful life of intravenous nutrition access devices.