I ran into these Dutch researcher who basically reduced line infections to near zero with Taurilidine locks. Their paper was presented at Oley, received the research award. This looks like a good option for those of us either: 1) not a fan of ethanol and its corrosive effects on lines, 2) not a fan of heparin and its freaky possible contaminants, or 3) still experiencing too many line infections with whatever protocol to be happy.
But more interesting to me was the conversation I had with them regarding AV fistulas and dressings. Apparently, none of their 100+ TPN-dependent patients (The Dutch population is in total ~16MM) use dressings at all. They claim that they have a much lower rate of tunnel infections because of this. Yes, the line is just hanging out there in the breeze, or shower, or pool, or whatever (!). I know, right?
And not to sound like I'm maligning the UK, but I've been in contact with a family from there who was trained to clean the site with normal saline and then stick a tegaderm on top. The child is 8 months old and has had 5 site infections. Sounds like the worst of both worlds to me. Yikes.
And as for AV fistula, they say that it's up to the patient to decide if they want a port, a broviac or an AV fistula, but that the fistulas have a lower rate of line infection, and that when the needle is removed for the day, it's just, well the arm that is there. But that the decision really depends on the patient's dexterity with the other hand and so forth.
