Bech Laura Fuglsang, Drustrup Lotte, Nygaard Louis, Skallerup Anders, Christensen Line Dahlstrøm, Vinter-Jensen Lars, Rasmussen Henrik Højgaard, Holst Mette
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
JPEN J Parenter Enteral Nutr. 2016 Sep;40(7):989-94. doi: 10.1177/0148607115579939. Epub 2015 Apr 7.
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).
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.
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).
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.
带隧道涤纶套中心静脉导管，包括希克曼导管和经外周静脉穿刺中心静脉导管（PICC），是家庭肠外营养（HPN）治疗中最常用的静脉通路。导管相关血流感染是最常见且严重的并发症。本研究调查了包括吸烟、家庭护理护士进行的导管管理、结肠造口术、每周输液天数以及置管日的C反应蛋白等环境危险因素是否会影响首次发生导管相关血流感染（CRBSI）的时间。
在这项为期6年（2008 - 2014年）的观察性队列研究中，纳入了通过希克曼导管或PICC接受HPN治疗的成年肠衰竭患者。通过查阅病历获取数据，并使用Cox比例风险模型分析环境危险因素。
共登记了136例患者置入的295根导管（希克曼导管：n = 169，PICC：n = 126）。使用PICC时，每周多1个输液日可使首次CRBSI时间显著缩短2.47倍。由家庭护理护士管理的希克曼导管每1000导管日的CRBSI平均（标准差）发生率显著增加，为1.45（0.68）。不由家庭护理护士管理的希克曼导管平均（标准差）发生率为0.56（0.24）。
使用PICC时，每周多1个输液日可缩短首次CRBSI时间，而由家庭护理护士管理希克曼导管会增加CRBSI平均发生率。未发现其他危险因素。
