家庭肠外营养感染并发症：经外周静脉置入中心静脉导管、隧道式导管和输液港的长期研究。

Infectious complications in home parenteral nutrition: A long-term study with peripherally inserted central catheters, tunneled catheters, and ports.

机构信息

Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain.

出版信息

Nutrition. 2019 Feb;58:89-93. doi: 10.1016/j.nut.2018.06.016. Epub 2018 Jul 11.

DOI:10.1016/j.nut.2018.06.016

PMID:30391696

Abstract

OBJECTIVE

Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being the preferred route of administration. Peripherally inserted central catheters (PICCs) have been used increasingly, but whether they should be preferred over other types of CVCs is still controversial. The aim of this study was to evaluate catheter-related complications of CVC in patients receiving HPN.

METHODS

All patients treated at our center for HPN from 2007 to 2017 were prospectively included. A specialized intravenous therapy team took care of these patients. Catheter-related bloodstream infections (CRBSI) were confirmed with positive, simultaneous, differential blood cultures drawn through the CVC and peripheral vein and then semiquantitative or quantitative culture of the catheter tip.

RESULTS

In all, 151 patients received HPN during the 11-y study period. Of these patients, 95 were women (63%) and 55 were men (37%), with a mean age of 58 ± 13 y. Twenty-six were non-cancer patients (17%) and the remaining 125 patients had an underlying malignancy (83%). Regarding the CVC, 116 were PICCs, 18 Hickman, and 36 ports. Confirmed CRBSI per catheter-days showed 0.15 episodes per 1000 catheter-days for PICCs, 0.72 for Hickman, and 2.02 for ports. PICCs had less-confirmed CRBSIs per 1000 catheter-days than ports (φ = 0.54, P = 0.005), but no difference between PICCs and Hickman was found (φ = 0.32, P = 0.110). Confirmed episodes of CRBSI (2 versus 13%, χ = 6.625, P = 0.036) were more frequent with multilumen catheters.

CONCLUSIONS

In our setting, single-lumen PICC and Hickman catheters showed low infectious complications.

摘要

目的

家庭肠外营养（HPN）已成为一种常见的治疗方法，其中经皮隧道式中心静脉导管（CVC）是首选的给药途径。外周置入中心静脉导管（PICC）的使用越来越多，但它们是否优于其他类型的 CVC 仍存在争议。本研究旨在评估接受 HPN 治疗的患者中 CVC 相关并发症。

方法

本研究前瞻性纳入了 2007 年至 2017 年期间在我院接受 HPN 治疗的所有患者。一个专门的静脉治疗团队负责照顾这些患者。导管相关性血流感染（CRBSI）通过同时从 CVC 和外周静脉抽取阳性、差异血培养，并对导管尖端进行半定量或定量培养来确认。

结果

在 11 年的研究期间，共有 151 名患者接受了 HPN 治疗。其中 95 名女性（63%），55 名男性（37%），平均年龄为 58 ± 13 岁。26 名非癌症患者（17%），其余 125 名患者患有恶性肿瘤（83%）。关于 CVC，116 例为 PICC，18 例为 Hickman，36 例为端口。每千导管日确诊的 CRBSI 发生率为 PICC 为 0.15 例，Hickman 为 0.72 例，端口为 2.02 例。PICC 每千导管日的确诊 CRBSI 发生率低于端口（φ=0.54，P=0.005），但 PICC 与 Hickman 之间无差异（φ=0.32，P=0.110）。多腔导管的确诊 CRBSI 发生率更高（2%比 13%，χ²=6.625，P=0.036）。