Effect of the Mode of Lipid Administration on Parenteral Nutrition-Related Infections

Abstract

Use of TNAs does not influence the rate of infection in patients receiving PN.

Risk Factors for the Development of Catheter‐Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

“…17 Our study reported herein is the first investigation to report an association between increased frequency of lipid emulsion infusion and development of CRBSI. Shouman et al 18 showed bacterial clearance was decreased in animals as well as in preterm infants with bacteremia who received IV lipid emulsion, 19-21 as the reticuloendothelial system may be impaired, [22][23][24] although actual infection risk may not be increased, at least among inpatients during short-term hospitalizations, 22,[25][26][27] with the exception of a study in trauma patients in whom the use of lipid emulsion within the first 10 days of PN was associated with increased infection rate, ICU stay, and total length of hospitalization.…”

Does Lipid Hang Time Make a Difference? Time Is of the Essence

“…Approximately 1 year later, a randomized control trial of 24-hour versus 72-hour IV tubing set changes in newborns receiving IVLE alone was conducted; a significant increase in mortality was observed when the IV administration set was changed at 72-hour intervals, compared with those changed at 24-hour intervals. 23 Unfortunately, given the earlier data regarding the differences in microbial growth potential and modes of infusing IVLEs as a separate infusion versus TNA, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] this outcome may have been predicted and therefore likely avoided. Table 1 reviews the salient points from critical references on microbial growth potential or infectious risk associated with IVLE therapy.…”

“…Thus, solid conclusions based on these study findings are difficult because of the small sample size and lack of statistical significance. A similar study was conducted by D'Angio et al, 19 but the hang time for separate IVLE infusion was limited to 12 hours to conform to CDC guidelines. This prospective, randomized clinical trial included 44 patients receiving a 3-in-1 admixture and 52 patients receiving a 2-in-1 PN formulation with IVLE administered separately as an IV piggyback.…”

“…17,18 Additional data further demonstrated the lack of association between TNAs and parenteral nutrition-related infections. 19 Then, in 1995, a CDC investigation reported on the significant morbidity and mortality associated with the extrinsic contamination of a soybean oil-based drug emulsion by clinical personnel. 20 In 1996, the CDC revised its "hang time" limits for IVLEs, making a clear distinction between TNAs to be hung for 24 hours, and an infusion of IVLEs given "alone," to be completed within 12 hours.…”

Home Parenteral Nutrition

“…This is unfortunate as S epidermidis , common skin flora, is a frequent cause of bloodstream infection in HPN patients 35 . Despite this theoretical risk, data from the Department of Veterans Affairs noted that the infection rate was similar in patients randomized to either 2‐in‐1 (10.3 per 1000 catheter days) or TNA (12.6 per 1000 catheter days) ( P = .89) 36 …”