Saqui Olivia, Fernandes G, Allard J
Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Br J Nurs. 2020 Apr 23;29(8):S34-S42. doi: 10.12968/bjon.2020.29.8.S34.
A lower central venous catheter (CVC) infection rate suggests an improvement in practice and education. CVC infection remains a complication that often requires significant health care resources. Use of tunneled CVC and patient education on catheter care reduces CVC infection rates.
CVC infection is one of the most frequent, life-threatening complications in home parenteral nutrition (HPN) patients. Our objective was to conduct a 5-year retrospective chart review regarding CVC infections in 3 adult HPN programs.
Data were collected from the Canadian HPN Registry and patient charts that include demography, infection diagnosis, blood cultures, and treatments.
Results are reported as median (range) ± standard error of mean or population frequency. Eighty-one charts were reviewed. Mean age was 51.98 ± 1.71 years. Short bowel syndrome (54.3%) was the primary diagnosis, with 36 months (range, 1324 months) median length of HPN therapy. Forty-seven subjects (58%) had infections over a 5-year period. Of these, there were 144 sepsis events. There was positive correlation (=0.423; <0.001) between number of infections and HPN duration. The median length of time the CVC was in place was 281 (range, 14-4380) days. There were 66.7% tunneled CVCs; 25.9% peripherally inserted central catheters (PICCs), and 7.4% implanted venous port. In this sample, there was no association between line infection and catheter type. Most patients presented with fever (58.3%) and chills (38.2%). Blood cultures were done (89.6%), and coagulase negative was the resulting pathogen present in 25.7%. Patients with bloodstream infection were treated for 17.9 ± 1.2 days with combination antibiotics (22.2%). Overall, the CVC infection rate was 0.97 per 1000 catheter days.
We found the standard approach to infection prevention is comparable to reports in literature. However, a subset of patients with multiple CVC infections require education with an emphasis on preventive techniques in order to reduce the incidence of infection.
较低的中心静脉导管（CVC）感染率表明在实践和教育方面有所改善。CVC感染仍然是一种并发症，常常需要大量医疗资源。使用隧道式CVC以及对患者进行导管护理教育可降低CVC感染率。
CVC感染是家庭肠外营养（HPN）患者中最常见的、危及生命的并发症之一。我们的目的是对3个成人HPN项目中的CVC感染情况进行为期5年的回顾性病历审查。
从加拿大HPN登记处和患者病历中收集数据，包括人口统计学、感染诊断、血培养和治疗情况。
结果以中位数（范围）±平均标准误差或总体频率报告。审查了81份病历。平均年龄为51.98±1.71岁。短肠综合征（54.3%）是主要诊断，HPN治疗的中位时长为36个月（范围为13 - 24个月）。47名受试者（58%）在5年期间发生了感染。其中，有144次败血症事件。感染次数与HPN持续时间之间存在正相关（=0.423；<0.001）。CVC留置的中位时间为281天（范围为14 - 4380天）。有66.7%的隧道式CVC；25.9%的外周静脉穿刺中心静脉导管（PICC），以及7.4%的植入式静脉端口。在这个样本中，导管类型与导管感染之间没有关联。大多数患者出现发热（58.3%）和寒战（38.2%）。进行了血培养（89.6%），凝固酶阴性菌是导致感染的病原体，占25.7%。血流感染患者接受联合抗生素治疗17.9±1.2天（22.2%）。总体而言，CVC感染率为每1000导管日0.97例。
我们发现感染预防的标准方法与文献报道相当。然而，一部分发生多次CVC感染的患者需要接受侧重于预防技术的教育，以降低感染发生率。
