Environmental Risk Factors for Developing Catheter‐Related Bloodstream Infection in Home Parenteral Nutrition Patients

Background: Tunneled, cuffed, central venous catheters, including Hickman catheters and peripherally inserted central venous catheters (PICCs), are the most commonly used venous access for home parenteral nutrition (HPN) therapy. Catheter‐related bloodstream infection is the most prevalent and severe complication. This study investigated whether environmental risk factors, including smoking, catheter management by a home care nurse, colectomy with stoma, number of infusion days per week, and C‐reactive protein at catheter insertion day, influenced the time to first catheter‐related bloodstream infection (CRBSI). Materials and Methods: In this 6‐year (2008–2014) observational cohort study, adult patients with intestinal failure receiving HPN through either Hickman catheters or PICCs were included. Data were obtained by reviewing medical records, and the environmental risk factors were analyzed with the Cox proportional hazards model. Results: A total of 295 catheters (Hickman catheters: n = 169 and PICCs: n = 126) inserted into 136 patients were registered. Using the PICCs, 1 additional infusion day per week showed to significantly decrease the time to first CRBSI by a factor of 2.47. Hickman catheters managed by a home care nurse had a significantly increased mean (SD) incidence of CRBSI of 1.45 (0.68) per 1000 catheter days. Hickman catheters not managed by a home care nurse had a mean (SD) incidence of 0.56 (0.24). Conclusion: Using the PICC, 1 additional infusion day per week decreased the time to first CRBSI, while having the Hickman catheter managed by a home care nurse increased the mean CRBSI incidence. No other risk factors were found.     

Role of Peripherally Inserted Central Catheters in Home Parenteral Nutrition

Background: Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being preferred for its administration. Peripherally inserted central catheters (PICCs) are not currently recommended for long‐term HPN, although evidence to support this statement is scarce. The authors aimed to evaluate the outcomes of HPN, focusing on CVC‐related complications. Materials and Methods: All patients attended at the authors’ center for HPN from 2007–2011 were prospectively included. HPN composition aimed at 20–35 kcal/kg/d, 3–6 g/kg/d of glucose, 1.0 g/kg/d of amino acids, and <1 g/kg/d of lipids. HPN was infused in an intermittent schedule, mostly at night. Catheter‐related bloodstream infections (CRBSIs) were confirmed with positive semi‐quantitative or quantitative culture of the catheter or simultaneous differential blood cultures drawn through the CVC and peripheral vein. Results: Seventy‐two patients received HPN, with 79 implanted CVCs (48 PICCs, 10 Hickman, and 21 ports). Mean catheter‐days were 129.1 for PICCs, 98.5 for Hickman, and 67.7 for ports (P = .685). When analyzing CRBSIs, ports had 44, Hickman had 20, and PICC had 0 episodes per 1000 catheter‐days (P = .078). Only PICCs showed less incidence of CRBSIs vs ports (P = .043). Multivariate logistic regression, correcting by catheter‐days, patients’ age and sex, underlying disease, and type of catheter, showed that only catheter‐days (P = .031) was a predictor for CRBSIs (P = .007, Nagelkerke R= = 0.246). Conclusion: PICCs are similar in terms of catheter‐related complications to other CVCs for the administration of HPN, especially for oncology patients with HPN lasting <6 months.     

Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials

A systematic review and meta-analysis of randomized controlled trials (RCTs) of selective decontamination of the digestive tract (SDD) was undertaken to evaluate the impact of this procedure on bacterial bloodstream infection and mortality. Data sources were Medline, Embase, Cochrane Register of Controlled Trials, previous meta-analyses, and conference proceedings, without restriction of language or publication status. RCTs were retrieved that compared oropharyngeal and/or intestinal administration of antibiotics as part of the SDD protocol, with or without a parenteral component, with no treatment or placebo in the controls. The three outcome measures were patients with bloodstream infection, causative micro-organisms, and total mortality. Fifty-one RCTs conducted between 1987 and 2005, comprising 8065 critically ill patients were included in the review; 4079 patients received SDD and 3986 were controls. SDD significantly reduced overall bloodstream infections [odds ratio (OR), 0.73; 95% confidence interval (CI), 0.59-0.90; P=0.0036], gram-negative bloodstream infections (OR, 0.39; 95% CI, 0.24-0.63; P<0.001) and overall mortality (OR, 0.80; 95% CI, 0.69-0.94; P=0.0064), without affecting gram-positive bloodstream infections (OR, 1.06; 95% CI, 0.77-1.47). The subgroup analysis showed an even larger impact of SDD using parenteral and enteral antimicrobials on overall bloodstream infections, bloodstream infections due to gram-negative bacteria and overall mortality with ORs of 0.63 (95% CI, 0.46-0.87; P=0.005), 0.30 (95% CI, 0.16-0.56; P<0.001), and 0.74 (95% CI, 0.61-0.91; P=0.0034), respectively. Twenty patients need to be treated with SDD to prevent one gram-negative bloodstream infection and 22 patients to prevent one death.     

Hickman catheter complications in marrow transplant recipients

The complications associated with the insertion and use of 95 single lumen and 312 double lumen Hickman right atrial catheters in 357 marrow transplant recipients were retrospectively analyzed. Three-hundred (84%) first inserted catheters were in place for a median of 93 days (range, 16-209) without complications and were removed electively. Thirty-nine (9.6%) of all catheters were removed for infections and 24 (5.9%) for mechanical complications. Ninety-five patients (26.6%) had 111 episodes of septicemia involving 128 separate organisms and 25 patients had 25 episodes of localized catheter infection with 26 separate organisms. The most frequently isolated organism was coagulase-negative staphylococcus. Twelve of 24 removals due to mechanical complications were caused by accidental pulling of the catheter by the patient.     

血管内插管的感染病因

纤维蛋白鞘是血管内插管的感染来源,它通常在中央静脉导管放置3天后形成。但只有大约50％的纤维蛋白鞘培养结果呈阳性。在那些培养结果阳性的病例中,细菌开始繁殖的时间因导管不同部位各不相同：皮下平均5．1天,导管尖端平均8．6天,导管腔内平均13．1天。导管上的细菌越来越多,就越可能发生炎症和血液感染。因导管导致血液感染的危险从小于2／1000器械使用天数（外周静脉留置针,外周穿刺中央静脉导管PICC,隧道式中央静脉导管,皮下输液装置）,10／1000器械使用天数（动脉导管和Swan-Ganz导管）,30－50／1000k器械使用天数（多通路中央静脉导管和肾透析肾插管）。影响血管内插管感染发生的内源性因素包括：宿主情况,细菌类型,导管材料以及制造工艺。人类非常容易感染葡萄球菌,免子却不这样。表面葡萄球菌需要粘多糖才能引起导管感染。硅胶材料的导管比聚氨酯、聚氯乙烯及特氟隆材料更容易发生感染,这可能与它的过度活化作用有关。影响血管内插管感染发生的外源性因素包括：无菌屏障的范围,皮肤消毒剂种类,穿刺人员是否经过专业培训,整个输液系统被外物介入的次数,高营养输液（酵母菌最易繁殖）,5％葡萄糖溶液（革兰氏阴性菌最易繁殖）以及脂质服液（糠疹癣菌最易繁殖）。     

NICU早产儿PICC导管相关血流感染高危因素的Meta分析

目的 通过Meta分析客观地确定NICU早产儿PICC导管相关血流感染的主要高危因素,为预防早产儿PICC导管相关血流感染提供一定的循证证据支持。方法 在线检索CNKI、万方、维普、Cochrane Library、PubMed、EMBASE等数据库,检索年限从各数据库建库起始至2019年1月,有关公开发表的早产儿PICC导管相关血流感染高危因素的文献,由两名研究员独立完成文献筛选、质量评价及资料提取,采用RevMan5.3软件进行Meta分析。结果 经筛选共纳入10篇文献（中文1篇,英文9篇）进行Meta分析。胎龄＜32周(OR=0.26, 95%CI:0.10~0.66),出生体重＜750g(OR=0.53, 95%CI:0.41~0.69),股三角部位置管(OR=1.67, 95%CI:1.31~2.11),置管耗时≥60min(OR=0.61, 95%CI:0.38~0.97),留置管时间≥30天(OR=2.41, 95%CI:1.75~3.31),留置CVC导管数量≥2个(OR=0.21, 95%CI:0.17~0.25)是高危因素。结论 胎龄愈小、出生体重越低、经股三角部位置管、置管耗时和导管留置时间越长、留置多个CVC导管是早产儿PICC置管后发生导管相关血流感染的高危因素,医护人员可采取有效预防措施,降低导管相关血流感染的发生率。     

Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital

Despite enormous clinical experience of using peripheral vascular catheters, there is still controversy over the incidence and clinical relevance of bloodstream infections caused by these devices and the measures for preventing them. We performed a prospective study to determine the clinical epidemiology and outcomes of nosocomial bloodstream infections caused by short- and mid-line peripheral venous catheters among a group of non-intensive care unit patients. Cases of peripheral venous catheter-related bloodstream infections (PVC-BSIs) were compared to cases of central venous catheter-related bloodstream infections (CVC-BSIs). From October 2001 to March 2003, 150 cases of vascular catheter-related bloodstream infections were identified among 147 patients. Seventy-seven episodes (0.19 cases/1000 patient-days) were PVC-BSIs and 73 episodes (0.18 cases/1000 patient-days) were CVC-BSIs. Compared with CVC-BSIs, patients with PVC-BSIs more often had the catheter inserted in the emergency department (0 vs 42%), had a shorter duration from catheter insertion to bacteraemia (mean: 15.4 vs 4.9 days) and had Staphylococcus aureus (33 vs 53%) more frequently as the causative pathogen. Among patients with PVC-BSIs, catheters inserted in the emergency department had a significantly shorter duration in situ compared with those inserted on hospital wards (mean: 3.7 vs 5.7 days). Patients with PVC-BSIs caused by S. aureus had a higher rate of complicated bacteraemia (7%) and higher overall mortality (27%) than patients with PVC-BSIs caused by other pathogens (0 and 11%, respectively). Bloodstream infections remain underestimated and potentially serious complications of peripheral vascular catheterisation. Targeted interventions should be introduced to minimise this complication.     

Prevention and treatment of implanted central venous catheter (CVC) - related sepsis: a report after six years of home parenteral nutrition (HPN)

Catheter-related sepsis is a serious and common complication in patients receiving home parenteral nutrition (HPN). Prevention measures, prevalence of infections, types of agents and implanted central venous catheters (CVC), effectiveness of antibiotic therapy have been evaluated in 221 patients consecutively followed in our unit from January 1995 to December 2000. The clinical diagnosis of catheter-related infection was made using well-defined criteria. Patients were divided into two groups: A and B, receiving instructions with different modalities: standard (A) and detailed (B), respectively. Sixty CVC-related sepsis occurred in 32 (14%) patients. A multivariate analysis showed that the duration of HPN (P<0.001; OR=0.9), type of catheter (P=0.009; OR=0.12) and type of disease (P=0.033; OR=4.92) significantly influence catheter infection. The type of implanted CVC (159 port-a-cath in 153 patients and 71 tunnelled in 68) seems to affect the infection rate, this being lower in tunnelled (P=0.03). Infection rate was lower in B vs A group (P<0.001) with all types of catheters, suggesting the preventive role of very careful training. In particular, the incidence of CVC-related sepsis was 6/1000 days of HPN (i.e. 6/1000 days of catheterization) in Group A and 3/1000 in Group B. Systemic and antibiotic lock therapy was performed with an 83% successful rate. Gram-positive bacteria were the most frequent CVC infection agents, which are usually eradicated by antibiotic therapy lasting 7 days.     

Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit

This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.     

Short peripheral venous catheters: effect of evidence-based guidelines on insertion, maintenance and outcomes in a university hospital

This study was designed to evaluate the impact of hospital-wide guidelines for short peripheral venous catheters (SPVC) insertion on the frequency of local catheter-related complications. In a 1051-bed Parisian university hospital, two observational, point prevalence surveys were undertaken in 1996 and in 1998, separated by implementation of written guidelines for SPVC insertion. The outcomes of SPVC insertion were defined as the presence or absence of local catheter-related complications (erythema, purulence around the insertion point, tenderness or induration along the cannulated vein). The proportion of polyurethane catheter materials used (56% vs. 81%, P<0.001), correct and sterile fixation (80% vs. 92%, P<0.05), non-movable catheters (92% vs. 98%, P=0.03) and insertion record (58% vs. 76%, P<0.01) increased between 1996 and 1998. The frequency of local catheter-related complications decreased (15% vs. 4%, P<0.01). Age >73 years [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.28-28.05] was positively associated with local catheter-related complications, whereas duration of insertion (until 72 h) (OR 0.29, 95% CI 0.09-0.89) and the implementation of guidelines (OR 0.26, 95% CI 0.09-0.67) were negatively associated with local catheter-related complications. The implementation of guidelines was independently negatively associated with local catheter-related complications (OR 0.31, 95% CI 0.09-0.97). The results suggest that hospital guidelines for SPVC insertion can improve catheter care and significantly reduce local catheter-related complications.     

Use of teicoplanin for Hickman catheter associated staphylococcal infection in immunosuppressed patients

Antibiotic-resistant coagulase-negative staphylococci are a frequent cause of infection in indwelling central venous (Hickman) catheters. Teicoplanin has been evaluated in the treatment of 19 immunosuppressed patients with staphylococcal Hickman catheter infections, nine of whom were septicaemic. All infections were eradicated, with minimal side effects. In 16 cases, the catheter was retained until no longer required. Two recurrent infections were eradicated by a second course of teicoplanin. We conclude that teicoplanin is an effective and well-tolerated antibiotic in the treatment of Hickman catheter infections in immunosuppressed patients.     

Central-venous-catheter-related bacteremia in neonatalogy

OBJECTIVE: The aim of this retrospective study was to identify the risk factors for catheter-associated bloodstream infection (CABSI) in neonates. METHOD AND RESULTS: Fifteen episodes of CABSI occurred in 108 central catheters over a period of one year (2002). The univariate analysis risk factors were birth weight (1.064 vs 1.413 g; P<0.001), gestation age (28 vs 31 weeks; P<0.001), blood transfusion (8/15 vs 3/34; P<0.01), corticosteroids (7/15 vs 3/34; P<0.01), nasal CPAP duration (13.6 vs 2 days; P<0.01). Nasal CPAP duration was the only risk factor independently associated with CASBI (OR=1.2, 95% confidence interval=1.09-1.5) in the multivariate logistic regression analysis. CONCLUSIONS: The risk of infection associated with low birth weight is multifactorial suggesting that host-related factors are important. Prevention remains difficult and a policy of strict aseptic catheter care must be promoted.     

Catheter‐Related Complications in Cancer Patients on Home Parenteral Nutrition

Background: Although home parenteral nutrition (HPN) is often indicated in cancer patients, many physicians are concerned about the risks potentially associated with the use of central venous access devices (VADs) in these patients. The aim of this prospective study was to investigate the actual incidence of VAD‐related complications in cancer patients on HPN. Methods: All adult cancer patient candidates for VAD insertion and HPN were enrolled. The incidence of complications associated with 4 types of VADs (peripherally inserted central catheter [PICC], Hohn catheter, tunneled Groshong catheter, and port) was investigated, as well as the most significant risk factors. Results: Two hundred eighty‐nine VADs in 254 patients were studied, for a total of 51,308 catheter‐days. The incidence of catheter‐related bloodstream infections (CRBSIs) was low (0.35/1000 catheter‐days), particularly for PICCs (0/1000; P < .01 vs Hohn and tunneled catheters) and for ports (0.19/1000; P < .01 vs Hohn and P < .05 vs tunneled catheters). Mechanical complications were uncommon (0.8/1000), as was VAD‐related venous thrombosis (0.06/1000). Ultrasound‐guided venipuncture was associated with a decreased risk of CRBSI (P < .04) and thrombosis (P < .001). VAD securement using sutureless devices reduced the risk of CRBSI and dislocation (P < .001). Hohn catheters had no advantage over PICCs (higher complication rate and shorter dwell time; P < .001). Conclusions: In cancer patients, HPN can be safely carried out with a low incidence of complications. Also, VADs are not equal in terms of complication rates, and strict adherence to meticulous insertion policies may effectively reduce catheter‐related complications.     

异位妊娠患者术后院内感染病原菌特征及危险因素分析

目的 探讨异位妊娠患者术后医院内感染病原菌特征并分析引发感染的危险因素。方法 选取2018年1月 - 2020年4月在我院接受异位妊娠手术患者260例,收集异位妊娠患者临床资料并统计患者术后院内感染情况,采集术后院内感染患者血液、尿液等临床标本,培养并鉴定病原菌分布情况,采用单因素与多因素logistic分析影响其院内感染的危险因素。结果 260例异位妊娠手术患者中有23例发生院内感染,感染率为8.85%,23例患者共分离出病原菌31株,其中革兰阳性菌17株（54.84%）,革兰阴性菌10株（32.26%）,真菌4株（6.45%）;经单因素分析显示:伴有其他基础疾病（χ2 = 12.496,P＜0.001）、手术时间≥2 h（χ2 = 11.782,P = 0.001）、术中出血量≥100 ml（χ2 = 6.779,P = 0.009）、住院时间≥2周（χ2 = 6.052,P = 0.014）、术后留置导管（χ2 = 7.856,P = 0.005）及卧床时间≥4周（χ2 = 5.426,P = 0.020）等因素是影响异位妊娠患者术后院内感染的因素;经多因素logistic分析显示:伴有其他基础疾病（OR = 4.860,95%CI:1.456～16.219,P = 0.010）、术后留置导管（OR = 48.777,95%CI:7.502～317.155,P＜0.001）、手术时间≥2 h（OR = 9.325,95%CI:2.035～42.725,P = 0.004）及住院时间≥2周（OR = 24.559,95%CI:3.394～177.695,P = 0.002）是患者术后院内感染的独立危险因素。结论 异位妊娠患者术后院内感染主要病原菌为革兰阳性菌,伴有其他基础疾病、术后留置导管、手术及住院时间过长等均为引发患者出现术后感染的重要危险因素。     

完全植入式中心静脉输液泵的应用探讨

目的 探讨完全植入式中心静脉输液泵的应用.方法 对217例完全植入式中心静脉输液泵的应用及并发症进行回顾性分析.结果经锁骨下静脉置管胸壁皮下输液泵植入199例,经颈内静脉置管胸壁皮下输液泵植入17例,植入成功率为99.6%(216/217).中心静脉输液泵植入后长期正常使用207例(95.8%),因并发症导致输液泵取出9例(4.2%).相关并发症:锁骨下动脉误穿3例(1.4%),并形成局部血肿1例;导管置入右心室导致室性心动过速1例(0.4%),泵体周围软组织感染5例(2.3%),经抗炎治疗无效并取出2例;导管脱位2例(0.9%);导管堵塞行输液泵取出6例(2.8%),其中导管扭曲3例,导管内血栓形成3例.总体并发症发生率为7.8%.结论 完全植入式中心静脉输液泵可以提供更加长期、安全的静脉通路,植入手术简单,但有一定的并发症发生率,需要注意监测.对于需要长期静脉输液的患者,特别是接受化疗的肿瘤患者具有较高的临床应用价值.     

Long-term central venous access vs other home therapies: complications in patients with acquired immunodeficiency syndrome.

One hundred and forty silicone catheters were inserted in 127 patients for long-term intravenous access with a cumulative follow-up time of 21,125 catheter-days (58 patient-years). Fifty-six patients had acquired immunodeficiency syndrome (AIDS); 44 were not AIDS patients and were receiving ambulatory home parenteral nutrition, whereas the remaining 27 did not have AIDS and were receiving home antibiotic therapy. Patients had a mean of 1.1 catheters inserted, and the rate of Hickman catheter-related sepsis was 0.18 per 100 catheter days or 0.6 septic episodes per patient year of treatment. Catheter-related sepsis was higher in AIDS patients (p < .01) and in patients receiving parenteral nutrition (p < .05) compared with those receiving antibiotic therapy. Prior catheter infection and AIDS were the most significant predictors of catheter infection (p < .01). Staphylococcus aureus was the most commonly isolated pathogen (61%) in AIDS patients. Fever (p < .001) and relative leukocytosis (p < .02) were the most common signs of infection. Only 14 infected catheters (37.8%) were salvaged by antibiotic therapy after the initial infection episode, and 6 of these catheters (42.9%) had recurrent multiple infections. In addition, inflammatory bowel disease was found to be a risk factor for venous thrombosis (p = .018). We conclude that because immunocompromised patients have a high risk of infection, catheter-related sepsis in these patients should be treated by catheter removal and antibiotics.     

A randomized, controlled trial of a new vascular catheter flush solution (minocycline-EDTA) in temporary hemodialysis access.

BACKGROUND AND OBJECTIVE: We previously demonstrated that minocycline-EDTA was efficacious at preventing catheter-related bloodstream infections (BSIs) in three patients with recurrent infections. This study compared heparin with minocycline-EDTA as flush solutions used among dialysis patients with central venous catheters, a high-risk group for catheter-related BSI. METHODS: Patients were enrolled within 72 hours of catheter insertion and randomized to receive heparin or minocycline-EDTA as a flush after each dialysis session. Each syringe containing flush solution was wrapped in orange plastic to conceal the type of solution it contained. Patients were observed for evidence of infection and catheter thrombosis. After catheters were removed, cultures were performed to determine whether microbial colonization had occurred. RESULTS: During a 14-month period, 60 patients were enrolled (30 in each group). The two groups had similar demographics and underlying diseases. Catheter survival at 90 days was 83% for the minocycline-EDTA group versus 66% for the heparin group (P = .07). Significant catheter colonization, a surrogate measure of catheter-related infection, was significantly more frequent in the heparin group (9 of 14 vs 1 of 11; P = .005). There was only one catheter-related bacteremia and it occurred in the heparin group. CONCLUSIONS: When compared with heparin, minocycline-EDTA had a better 90-day catheter survival (P = .07) and a decreased rate of catheter colonization. This pilot study warrants a larger prospective, randomized trial.     

Tip position of long-term central venous access devices used for parenteral nutrition

BACKGROUND: Venous thrombosis is a potential postplacement complication of a central venous access device (VAD). Improper catheter tip position is a predisposing factor, especially when the device is used to administer parenteral nutrition (PN). American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend that a central VAD used for PN be placed with its tip in the superior vena cava (SVC) adjacent to the right atrium (RA). The purpose of this study is to determine the prevalence of improper central VAD tip position and factors associated with malpositioning. METHODS: All adult patients with a longterm VAD (ie, tunneled central venous catheter, peripherally inserted central catheter [PICC], or implanted port) placed before the current admission who were scheduled to receive PN also received chest x-rays to evaluate position of the catheter tip. Position was determined by a staff radiologist. A catheter with its tip ranging from the middle third of the SVC to the RA was considered acceptable; a catheter with its tip in any other position was considered malpositioned. Subjects with multiple VADs or multiple evaluations for the same catheter had the first placement and last evaluation considered. A logistic regression analysis was used to study the univariable and multivariable associations of these factors with tip malposition. RESULTS: Data were collected for catheters in 124 patients, including 74 tunneled catheters (71 Hickman, 2 Broviac, 1 Groshong), 38 PICCs, and implanted ports. Most of the catheters were placed for (81.9%) or chemotherapy (14.5%). Median catheter duration was 1.6 months at time of evaluation. Of 138 catheters studied, 15.9% (95% confidence interval, 10.2-23.1) were malpositioned at time of evaluation. According to univariable analysis, factors associated with malpositioned catheters included shorter catheter duration (p = .001), greater number of lumens (p = .029), venous entry site on the arm (p <.001) and catheters placed at institutions other than Cleveland Clinic (p = .007). Additionally, PICCs were likely to be malpositioned at time of evaluation compared with other long-term VADs combined (34.2% vs 9.0%; p < .001). CONCLUSIONS: A high percentage of long-term VADs improperly positioned for PN in the present study. were more likely to be malpositioned at time of evaluation compared with tunneled catheters and implanted These findings suggest the tip position of long-term should be confirmed before infusing PN.     

Bloodstream Infections in Patients Receiving Manufactured Parenteral Nutrition With vs Without Lipids

Background: This study compared overall bacterial and bloodstream infection rates in patients receiving premixed parenteral nutrition (PN) with vs without lipid emulsion. Methods: Data from hospitalized patients who were ≥18 years of age and receiving premixed PN between 2005 and 2007 were extracted from the Premier Perspective database. Data were categorized into 2 groups: patients who received premixed PN only and those receiving premixed PN with lipids. Multiple logistic regression was used to adjust for risk factors and potential confounders, reporting the probability of risk for an infection. Results: The group without lipids was observed to have lower rates of both overall bacterial infection (43.5% vs 53.5%) and bloodstream infection (14.5% vs 18.9%). However, after adjusting for baseline characteristics, there were no significant differences in overall risk of bacterial infections (51.4% vs 53.5%; odds ratio [OR] = 1.11; 95% confidence interval [CI], 0.96–1.27) or bloodstream infections (19.6% vs 19.2%; 0.97; 0.81–1.16). In a subset of patients in the intensive care unit for ≥3 days, lower overall bacterial infection rates (58.3% vs 67.3%) and bloodstream infection rates (31.0% vs 37.0%) were observed in the group without lipids. After adjustment, there were no significant differences in risk of overall bacterial infection (OR = 0.95; 95% CI, 0.75–1.22) or bloodstream infection (0.92; 0.71–1.19) between the 2 groups. Conclusions: When administered with premixed PN, lipid emulsion was not significantly associated with an increase in the risk of infectious morbidity when compared to omitting lipids from therapy.     

Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients

A prospective cohort study was performed to evaluate the influence of catheter manipulations on catheter associated bloodstream infection (CABSI) in neonates. Neonates admitted between 1 November 1993 and 31 October 1994 at the neonatal intensive care unit of a university hospital were included in the study. Seventeen episodes of CABSI occurred in 357 central catheters over a period of 3470 catheter-days, with a cumulative incidence of 4.7/100 catheters and an incidence density of 4.9/1000 catheter-days. Patient and catheter-related risk factors independently associated with CABSI were: catheter hub colonization (odds ratio [OR] = 32.6, 95% confidence interval [95% CI] = 4.3-249), extremely low weight (相似文献