Review article: psychological aspects of home parenteral nutrition, abnormal illness behaviour and risk of self-harm in patients with central venous catheters.

BACKGROUND Home parenteral nutrition is established as standard management for patients with chronic severe intestinal failure. Although the treatment is welcomed by many patients, there are psychological consequences of living with a central venous catheter and there are associated restrictions to the lives of patients on home parenteral nutrition. A subgroup of home parenteral nutrition patients may use their central venous catheter for self-harm. AIMS To review existing literature relating to abnormal psychological responses to central venous catheters in patients receiving home parenteral nutrition and the psychological meaning of living with a central venous catheter. It also attempts to alert professionals to ways in which patients may self-harm using their central venous catheters. METHODS A literature review was performed. Data were obtained both from literature searches and from personal experience at a Psychological Medicine Unit attached to a large home parenteral nutrition centre. RESULTS Patients receiving home parenteral nutrition may use their central venous catheter in various ways to self-harm. Motivation may be conscious or unconscious. Sequelae of such self-harm may be life-threatening. CONCLUSION This paper concludes with recommendations for best practice with respect to the psychological management of home parenteral nutrition patients in whom central venous catheter abuse is suspected.