Impact of a new guideline for central venous catheter care on sepsis in total parenteral nutrition: Experience in Ramathibodi Hospital

Abstract

Background: Total parenteral nutrition (TPN) is the essential treatment for hospitalized patients in whom normal enteral nutrition is inadequate or not feasible. However, TPN-related sepsis is the most serious and fatal complication of the treatment and the catheter is the most common cause of infection. Therefore, the Nutrition Support team in Ramathibodi Hospital has developed a new guideline for central venous catheter care for TPN patients and has used it for at least a year. Objective: Survey the current incidence of TPN-related sepsis in the hospital, the predisposing factors of the TPN-related sepsis, and the pathogenic organisms of the sepsis. Material and Method: Between July 1999 and February 2000, 52 TPN treatments (catheter count) in 40 surgical and medical patients were prospectively recruited. Microbiological studies were done in all cases of TPN-related sepsis. Results: The incidence of TPN-related sepsis was 15% per catheter or 12.64/1000 catheter-days. Although no statistically significant predisposing factors were found for the sepsis, some factors such as postoperative TPN and short interval (≤ 2 days) for TPN line change (OR = 3.33, 95% CI = 0.33-30.34) showed a higher risk for TPN-related sepsis. The most common pathogenic organisms were Coagulase-negative staphylococci, Candida albicans, and gram-negative bacteria. The organisms were found from hemoculture in septic patients and were well correlated with those found in the catheter line. Thus, the significant pathogenic role of Coagulase-negative staphylococci emphasizes the importance of aseptic technique during catheterization. Conclusion: The Ramathibodi guideline rendered support for a good policy to improve and standardize the TPN treatment. Along with a practical guideline, the well-trained and highly responsible personnel would also be crucial to avoid the infectious complications.