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During a dressing change, the parents note the central line exit site looks different (see photo below). What is the problem? A. Central venous catheter cuff exposed B. Cellulitis at central line exit site C. Eczema at central venous catheter exit site D. Central line exit-site and tunnel infection...

A 25 year-old patient with a Port-a-Cath implanted in the right chest complains of sudden onset severe neck pain and headaches with flushing central line and PN infusions. Labs and exam normal, including afebrile. Previous X-ray shows central line tip in at the cavo-atrial junction. Today, chest X...

Appreciate the contributions of the following and others to the website's content: Alexandra Carey, MD Daniel Kamin, MD Jennifer McClelland, FNP-BC Carolyn Rosa, CPNP-BC Mary Gallotto, BSN Melissa Takvorian-Bene, BSN Megan Gray, RD Ana Arena, RD Christina Tascione, BA Kathleen Gura, PharmD Margaret...

You are consulted as the HPN expert by the inpatient cardiology team to facilitate discharge for a 3 year-old female with a history of heart transplant for hypoplastic left heart syndrome was admitted for new onset 3-week history of vomiting, diarrhea and weight loss. Diagnostic laboratory and...

A 25 year-old patient with a Port-a-Cath implanted in the right chest complains of sudden onset severe neck pain and headaches with flushing central line and PN infusions. Labs and exam normal, including afebrile. Previous X-ray shows central line tip in at the cavo-atrial junction. Today, chest X...

Population Home parenteral nutrition is a life-sustaining therapy provided to ~40,000 people in the United States. Delegge MH. Demographics of home parenteral nutrition. JPEN J Parenter Enteral Nutr. 2002 Sep-Oct;26(5 Suppl):S60-2. Review. PubMed PMID: 12216724. Total annual care In 2008...

Pathophysiology: Mutations EPCAM Disordered fixation protein expression along the basolateral membrane of intestinal epithelium (especially in crypts), which leads to the consequence of tufts along villi. Salomon J, Espinosa-Parrilla Y, Goulet O, Al-Qabandi W, Guigue P, Canioni D, Bruneau J...

Parent of a 1 year-old female on home parenteral nutrition secondary to short bowel syndrome (necrotizing enterocolitis) calls with a 2-day history of fever 101 degrees Fahrenheit (38.3 degrees Celsius). There are no other clinical complaints besides from teething. What is the next step? A...

5 year-old male with long-term HPN dependence secondary to short bowel syndrome is seen for routine follow-up. Enteral tolerance is currently maximized. PN currently providing energy 45 kcal/kg/day, protein 1.3 gram/kg/day, IV soybean lipids 1 gram/kg/day, glucose infusion rate 10 mg/kg/minute...

6 month-old male on home parenteral nutrition presents to emergency department with sudden onset altered mental status. On exam, patient is non-responsive, temperature 35 degrees Celsius, HR 180, blood pressure undetectable, skin is modeled. The central line site is clear. Blood cultures have been...