Graham D R, Keldermans M M, Klemm L W, Semenza N J, Shafer M L
Springfield Clinic, Illinois.
Am J Med. 1991 Sep 16;91(3B):95S-100S. doi: 10.1016/0002-9343(91)90351-w.
Rates of bacteremia among hospitalized patients with central venous catheters range up to 21%. Few data exist for home intravenous therapy (IVT). We studied 300 patients from two hospital-based home IVT services in 29 months. Diagnoses included 92 cases of osteomyelitis, 33 of pneumonia, 35 of malnutrition, 26 of chronic pain, and 114 of other diseases. Peripheral IVT was given to 97 patients. Mean age was 39.4 years (range, 0.3-98). Hickman, Infuse-A-Port, Broviac, Arrow triple lumen, Hohn, and peripherally inserted central catheters (PICC) were used for a mean of 44 days. Six bacteremias (one death) (2%, 4.6/10,000 catheter days), two subclavian thromboses, 13 catheter site infections, and one additional death occurred. PICC experience included 76 patients, mean age 46 years (range, 4-76), primarily with infections, chronic pain, or dehydration. Mean duration of therapy was 24 days (0-67) and was completed in 51 patients; others completed therapy with standard peripheral catheters a mean of 6 days later. Complications included 17 obstructions by clot, 11 cases of phlebitis, six catheter fractures, five punctures, two accidental removals, and one infiltration. Liquid silicone repaired holes; urokinase opened clots. Successful completion of therapy was more common in the second year, 88% versus 57%. Despite more complications, patients, home IVT nurses, and physicians preferred PICCs. We conclude that home IVT is safe via many means of access, with fewer infections than with hospital care. Such infections may be termed "nosohusial."
住院的中心静脉导管患者的菌血症发生率高达21%。关于家庭静脉内治疗（IVT）的数据很少。我们在29个月内对来自两家医院家庭IVT服务的300名患者进行了研究。诊断包括92例骨髓炎、33例肺炎、35例营养不良、26例慢性疼痛和114例其他疾病。97名患者接受了外周IVT。平均年龄为39.4岁（范围0.3 - 98岁）。使用Hickman、Infuse - A - Port、Broviac、Arrow三腔、Hohn和外周插入中心静脉导管（PICC）的平均时间为44天。发生了6例菌血症（1例死亡）（2%，4.6/10000导管日）、2例锁骨下血栓形成、13例导管部位感染和1例额外死亡。PICC经验涉及76名患者，平均年龄46岁（范围4 - 76岁），主要患有感染、慢性疼痛或脱水。平均治疗持续时间为24天（0 - 67天），51名患者完成了治疗；其他患者平均6天后用标准外周导管完成治疗。并发症包括17例血栓阻塞、11例静脉炎、6例导管断裂、5次穿刺、2次意外拔除和1次渗漏。液态硅胶修复了孔洞；尿激酶溶解了血栓。治疗成功完成在第二年更为常见，分别为88%和57%。尽管并发症更多，但患者、家庭IVT护士和医生更喜欢PICC。我们得出结论，通过多种通路进行家庭IVT是安全的，感染比住院治疗少。这种感染可称为“医院获得性感染”。
