MON-PP018: Clinical Benefits of Pump Infusion Pressure Monitoring in Patients on Home Parenteral Nutrition

Abstract

Rationale: Previous industry liaison resulted in a system to monitor infusion pressures [1]. This follow-on study aimed to identify the normal pressures in patients on home parenteral nutrition (HPN) and if these could aid in the diagnosis and treatment of catheter problems. Methods: 27 patients consented to be monitored. Pressures were recorded on the Micrel PN+ pump and exported to a secure server. Any HPN patient with a partial or total catheter occlusion had infusion pressures measured pre and post patency intervention. Results: 5910 infusions were recorded from 27 patients. Average infusion pressure was 0.29±0.1 bar (0.01 0.85) and did not increase with infusion rate (r = 0.3). 21 (78%) patients had open ended devices, 4 (15%) valved and 2 (7%) implanted ports. There was no difference between devices p = 0.91. There were 62 (1%) readings above the Upper Confidence Interval of 0.58 bar from 7 patients. 50 (81%) were from 1 patient with a valved port who reported multiple downstream occlusions. The alarms stopped after changing to a longer HuberTM needle, but high readings were still recorded. Comparison with readings from a non valved port revealed those from the valved port were significantly higher p < 0.0001. 1 patient with clinically confirmed thrombosis had a pressure spike of 0.67 bar 5 days before presenting with symptoms. Pressures in the preceding 6 months were within normal limits ( 0.58 bar). 6 patients (not on the Micrel PN+) had a partial or total occlusion. Mean preintervention pressure was 0.31±0.048 bar, post-intervention it was 0.2±0.055 bar, p = 0.007. Conclusion: This study describes the normal range of infusion pressures in patients on HPN and how these might be used in the diagnosis and treatment of catheter problems such as occlusion or thrombosis. Sudden spikes in infusion pressure may be indicative of an upcoming complication, however further study is needed.