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Going With the Flow or Swimming Against the Tide
Author(s) -
Miller Jessica,
Dalton Meghan K.,
Duggan Christopher,
Lam Shirley,
Iglesias Julie,
Jaksic Tom,
Gura Kathleen M.
Publication year - 2014
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0884533613515931
Subject(s) - medicine , flow (mathematics) , oceanography , aeronautics , mechanics , geology , engineering , physics
Children who require long‐term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life‐sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter‐related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well‐designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence‐based recommendation.