Infection control during parenteral nutrition therapy.

Parenteral nutrition therapy can achieve an anabolic state in patients who are unable to maintain normal nitrogen balance; however, it may be associated with infectious complications. Infections may be related to contamination of the cannula and the cannula wound, of the infusate, or of other parts of the parenteral nutrition system. A variety of microorganisms has been associated with these infections. The exact mechanisms that initiate cannula-related infection are poorly understood. Susceptibility of the host, the method and site of cannula insertion, colonization of parenteral nutrition cannulas, use of parenteral nutrition systems for multiple purposes, cannula material, and other factors may all play some role. Controlling infections depend on many factors, including quality control processes to ensure sterility of parenteral nutrition solutions, attention to aseptic technique during cannula insertion, procedures to prevent in-use contamination, proper care of the cannula insertion site, and proper management of other parts of the parenteral nutrition system. In addition, infectious complications appear to be reduced by an organized team that follows infection control protocols. Many facets of parenteral nutrition therapy are based on data from uncontrolled clinical investigations. Well-designed, controlled clinical trials may provide data that will further minimize the risks associated with parenteral nutrition therapy.