Catheter Complications in Total Parenteral Nutrition

Ryan, John A.; Abel, Ronald M.; Abbott, William M.; Hopkins, Cyrus C.; Chesney, Thomas McC.; Colley, Rita; Phillips, K.; Fischer, Josef E.

doi:10.1056/nejm197404042901401

Cited by 641 publications

(59 citation statements)

References 24 publications

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“…An important potential complication related to TPN administrasocial security numbers -those with an even number received tion is catheter-related sepsis (CRS) [1]. Some studies have a double-lumen catheter (DLC) , while those with an odd numsuggested that the risk of CRS is increased by the use of tripleber received a TLC.…”

mentioning

confidence: 99%

Total Parenteral Nutrition via Multilumen Catheters Does Not Increase the Risk of Catheter-Related Sepsis: A Randomized, Prospective Study

Thomas¹,

Yoshinaka²,

Banaag³

et al. 1998

Clinical Infectious Diseases

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The purpose of this study was to determine in a randomized, prospective manner whether administration of total parenteral nutrition (TPN) via multilumen catheters increases the risk of catheterrelated sepsis (CRS). All patients receiving hyperalimentation during a 24-month period were randomized to receive either a double-lumen catheter (DLC) or a triple-lumen catheter (TLC). A total of 101 catheters were placed in 79 patients, of which 49 were DLCs and 52 were TLCs. The patients with DLCs received a total of 784 days of TPN, whereas patients with TLCs received a total of 754 days of TPN. CRS was associated with one (2.0%) of the 49 DLCs vs. one (1.9%) of the 52 TLCs. In comparison, the rate of CRS associated with single-lumen catheters (historical control) at our institution was 1.4% (P ú .90). We conclude that the use of multilumen catheters in TPN therapy does not result in an increased risk of CRS.Total parenteral nutrition (TPN) is required in many hospitalnity to participate in this open, randomized, prospective trial.Patients were randomized to receive catheters according to their ized patients who cannot meet their nutritional needs enterally. An important potential complication related to TPN administrasocial security numbers -those with an even number received tion is catheter-related sepsis (CRS) [1]. Some studies have a double-lumen catheter (DLC) , while those with an odd numsuggested that the risk of CRS is increased by the use of tripleber received a TLC. Informed consent was obtained from each lumen catheters (TLCs) [2 -4]. Previous studies have shown patient in accordance with Veterans Administration guidelines. that administration of TPN through TLCs is associated with aThe study was approved by the Department of Veterans Affairs higher risk of CRS than is administration through single-lumen (Long Beach) Human Studies Committee and Research and catheters (SLCs) [2 -4]. The rate of CRS related to TLCs has Development Committee. been reported to be as high as 10% -25%, compared with a Both DLCs and TLCs were polyurethane 7F catheters rate of 0 -6% associated with SLCs [2 -4]. Thus, the use of (Arrow International, Reading, PA) that were made to be in-TLC in TPN therapy has been deemed unsafe by some investiserted over a guide wire by means of the Seldinger technique. gators. Because many of the patients who require TPN therapy All catheters were inserted by surgical or medical house staff are critically ill and have poor venous access, the use of TLCs by using a sterile technique and were sutured to the skin. Strict in these patients would allow additional access ports for admincompliance with the sterile technique was ensured by having istration of compatible medications and intravenous solutions the nutritional support team (NST) nurse present at all proceand eliminate the need for additional intravenous catheters.dures. The catheter was inserted into the internal jugular or the The purpose of this randomized, prospective study was to subclavian vein, depending on the preference of the individu...

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mentioning

confidence: 99%

Total Parenteral Nutrition via Multilumen Catheters Does Not Increase the Risk of Catheter-Related Sepsis: A Randomized, Prospective Study

Thomas¹,

Yoshinaka²,

Banaag³

et al. 1998

Clinical Infectious Diseases

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“…In addition, reduction in the time a patient spends on TPN will reduce the associated TPN complications.' [1][2][3][4][5][6][7][8][9][10][11][12][13] …”

Section: Discussionmentioning

confidence: 99%

The Effect of Acute Discontinuation of Total Parenteral Nutrition

Wagman

Newsome

Miller

et al. 1987

Survey of Anesthesiology

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The present study was undertaken to assess the impact of acute discontinuation (AD) of total parenteral nutrition (TPN) on serum glucose, insulin, and glucagon levels and on the generation of symptomatic hypoglycemia. Fifty studies were performed in 48 patients. In none of the 30 studies of 1 hour duration nor in the 20 studies of 8 hours duration was there a single episode of symptomatic hypoglycemia. One patient had a glucose below normal (60 mg/dl) during the first hour after AD. Glucose and insulin concentrations were elevated at the start of TPN discontinuation but returned to normal values within 60 minutes and remained there during the successive 7 hours of study. Although glucagon levels were slightly elevated at zero time, no significant decrease occurred. There was no evidence for counter-regulation based on the patterns of glucose and hormone levels. With some restrictions, acute discontinuation is a safe, rapid method of ending a prolonged TPN infusion.TNHE SEQUENTIAL REDUCTION of glucose concentration before discontinuation oftotal parenteral nutrition (TPN) is termed tapering. The theoretical basis for tapering is that the endocrine pancreas is "turned on" by the continuous infusion ofa glucose load at approximately 0.6 g glucose/min. The sudden withdrawal of the glucose by discontinuing TPN, in the presence of elevated insulin levels, was thought to result in a rapid reduction of serum glucose levels. The total glucose and amino acid load delivered daily with TPN is calorically equivalent to that taken during the three meals normally ingested. However, man, as a "meal eater," usually has a cyclic elevation in serum glucose and serum immunoreactive insulin (IRI) levels. The cyclic phenomenon is very different from the persistently elevated levels of The purpose of this study was to examine the effects of acute cessation of a glucose infusion in patients receiving prolonged infusions of TPN. The effects of diabetes, exogenous insulin administration, and primary diagnosis were also evaluated. Specifically, the presence or absence of the phenomenon of rebound hypoglycemia was evaluated following acute cessation of the standard glucose infusion rates used in TPN (0.55 g glucose/min). Materials and MethodsPatients who were placed on total parenteral nutrition for at least 7 days were eligible for inclusion into the study. The study protocol was judged to contain the appropriate ethical standards by the Committee on the Conduct of Human Research at the Medical College of Virginia. The presence of diabetes or the need for exogenous insulin while on TPN did not constitute an exclusion. Those excluded were patients with hepatic failure, renal failure requiring dialysis, or clinical features of an underlying or primary disease that would obfuscate the clinical diagnosis of hypoglycemia (e.g., coma, expressive aphasia, and inability to communicate).A total of48 patients were included in one oftwo study protocols involving observation periods of 1 or 8 hours.524

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“…The importance of nursing/medical practice in the maintenance of the insertion site and administration system in modifying the infection rate is seen by the influence of specialist practitioners: In a prospective study of 200 catheters by Ryan et al (1974), catheters maintained with strict aseptic technique had a sepsis rate of 3% as compared to 20% when breaks in protocol were observed (p=0.01). Haddock et al (1985) found that when a designated nutrition nurse was responsible for catheter management, catheter-related sepsis fell from 36% to 10% when compared to a six month period during which catheter management was the responsibility of general nursing staff.…”

Section: Use Of the Central Linementioning

confidence: 99%

“…This perhaps indicates a low index of suspicion. Removal of the catheter when catheter-related infection is suspected leads to unnecessary removal in upto 75% of cases (Ryan et al 1974). Pettigrew et al (1985) noted that 30% of TPN catheters were removed for suspected sepsis of which 90% were not proven.…”

Section: The Temporal Incidence Of Infectionmentioning

confidence: 99%