Kemp L, Burge J, Choban P, Harden J, Mirtallo J, Flancbaum L
Nutrition Support Service, Ohio State University Hospitals.
JPEN J Parenter Enteral Nutr. 1994 Jan-Feb;18(1):71-4. doi: 10.1177/014860719401800171.
Infections pose a major problem in patients receiving total parenteral nutrition. Controversy continues concerning the effect of catheter type (triple-, double-, single-lumen, or pulmonary artery), insertion site (subclavian, internal jugular, or femoral vein), and the incidence of catheter-related infections. We retrospectively studied multi-lumen catheter use for total parenteral nutrition over a 6-month period in 192 patients, a total of 3334 catheter days. Nonintensive care unit catheters were inserted by the Nutrition Support Service, and intensive care unit catheters were inserted by the intensive care unit staff. All catheters were cared for using Nutrition Support Service protocols, with multi-lumen catheters changed every 7 to 10 days and pulmonary artery catheters changed every 4 days. Infections were determined by semiquantitative cultures (> 15 colonies/plate). The incidence of infections for triple-lumen catheters was 5 (subclavian), 17 (internal jugular), and 36% (femoral) respectively; total infection rate for triple-lumen catheters was 10%. Infection rates for pulmonary artery catheters were 4 (subclavian), and 6% internal (jugular site), respectively, the overall infection rate was 5%. There were no differences in infection rates at any site based on catheter type; however, when triple-lumen catheter sites were compared, the differences were significant (p < .001 vs subclavian, chi 2). Catheter duration was 7.8 days (subclavian),, 7.3 days (internal jugular), and 4.6 (femoral) days. These data suggest that the use of multi-lumen catheters for total parenteral nutrition is safe, that there is a benefit associated with the subclavian route, and that the femoral site should be avoided.
感染是接受全胃肠外营养患者面临的一个主要问题。关于导管类型（三腔、双腔、单腔或肺动脉导管）、插入部位（锁骨下静脉、颈内静脉或股静脉）以及导管相关感染的发生率的影响，争议仍在继续。我们回顾性研究了192例患者在6个月期间使用多腔导管进行全胃肠外营养的情况，共计3334个导管日。非重症监护病房的导管由营养支持服务部门插入，重症监护病房的导管由重症监护病房的工作人员插入。所有导管均按照营养支持服务方案进行护理，多腔导管每7至10天更换一次，肺动脉导管每4天更换一次。感染通过半定量培养（>15个菌落/平板）来确定。三腔导管的感染发生率分别为锁骨下静脉5%、颈内静脉17%和股静脉36%；三腔导管的总感染率为10%。肺动脉导管的感染率分别为锁骨下静脉4%和颈内静脉部位6%，总体感染率为5%。基于导管类型，各部位的感染率没有差异；然而，当比较三腔导管的插入部位时，差异具有统计学意义（与锁骨下静脉相比，p<0.001，卡方检验）。导管使用时长分别为锁骨下静脉7.8天、颈内静脉7.3天和股静脉4.6天。这些数据表明，使用多腔导管进行全胃肠外营养是安全的，锁骨下静脉途径有一定益处，应避免使用股静脉部位。
