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Central venous catheter infection in Canadian home parenteral nutrition patients: a 5-year multicenter retrospective study

23 April 2020
Association for Vascular Access
02 April 2020
Volume 29 · Issue 8

Abstract

HIGHLIGHTS

A lower central venous catheter (CVC) infection rate suggests an improvement in practice and education.

CVC infection remains a complication that often requires significant health care resources.

Use of tunneled CVC and patient education on catheter care reduces CVC infection rates.

Objectives:

CVC infection is one of the most frequent, life-threatening complications in home parenteral nutrition (HPN) patients. Our objective was to conduct a 5-year retrospective chart review regarding CVC infections in 3 adult HPN programs.

Methods:

Data were collected from the Canadian HPN Registry and patient charts that include demography, infection diagnosis, blood cultures, and treatments.

Results:

Results are reported as median (range) ± standard error of mean or population frequency. Eighty-one charts were reviewed. Mean age was 51.98 ± 1.71 years. Short bowel syndrome (54.3%) was the primary diagnosis, with 36 months (range, 1324 months) median length of HPN therapy. Forty-seven subjects (58%) had infections over a 5-year period. Of these, there were 144 sepsis events. There was positive correlation (r=0.423; P<0.001) between number of infections and HPN duration. The median length of time the CVC was in place was 281 (range, 14–4380) days. There were 66.7% tunneled CVCs; 25.9% peripherally inserted central catheters (PICCs), and 7.4% implanted venous port. In this sample, there was no association between line infection and catheter type. Most patients presented with fever (58.3%) and chills (38.2%). Blood cultures were done (89.6%), and coagulase negative Staphylococcus was the resulting pathogen present in 25.7%. Patients with bloodstream infection were treated for 17.9 ± 1.2 days with combination antibiotics (22.2%). Overall, the CVC infection rate was 0.97 per 1000 catheter days.

Conclusion:

We found the standard approach to infection prevention is comparable to reports in literature. However, a subset of patients with multiple CVC infections require education with an emphasis on preventive techniques in order to reduce the incidence of infection.

Home parenteral nutrition (HPN) is indicated in patients who are unable to effectively use their gastrointestinal tract due to intestinal failure, motility disorders, obstructions, and so forth. HPN allows patients to leave the hospital and resume a near-normal lifestyle. However, HPN is technically and socially complex. Providing HPN demands a patient-centered care approach by a specialized nutrition support team that includes a nurse, dietitian, pharmacist, and physician.

The standard plan of care for safe and effective HPN therapy includes insertion of a central venous catheter (CVC) through which the custom-made parenteral nutrition (PN) prescription is infused with an electronic pump to accurately run PN overnight while the patient sleeps. The patient and family/caregiver must learn the mechanical intricacies of administering PN and the vigilant maintenance of the CVC prior to going home. Once home, patients are visited by community nurses to ensure care of the catheter and proper administration of HPN are maintained. Routine parameters in managing outpatient HPN include regular clinic visits, blood tests, and telephone triage if complications arise. Routine blood tests are done not only for the adjustment of the fluid, electrolytes, and nutrient admixture but also to monitor and prevent metabolic abnormalities such as hyperglycemia and kidney injury from dehydration as well as potential outcomes associated with long-term use, such as PN-associated liver disease. Among other complications, CVC infection is the most frequent and serious.

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Central venous catheter
Home parenteral nutrition
Bacteremia