Parenteral nutrition line sepsis: A 10-year experience in a large teaching hospital

Abstract

The correct and early recognition of central venous catheter (CVC) related complications is vital in self caring home parenteral nutrition (HPN) patients. This study aimed to assess patient's knowledge of complications over time, to determine if a high knowledge score was associated with accuracy in detecting problems, and if the method of assessment affected scores. Patients attending clinic completed a quiz covering knowledge of catheter related bloodstream infection (CRBSI), local infection, occlusion and thrombosis. The quiz was repeated annually. In year 1 and 2 the quiz had open format questions, with patients listing possible symptoms. This was changed in year 3 to closed format questions with multiple choice answers. Complications during the 3 years were recorded. Data was obtained from 12 patients mean age 47(26-73) years. Median time on HPN 7 (4-22) years. Mean year 1 scores 72(56-88)%. Mean year 2 scores 79 (30-96)%. The difference was not significant P¼0.1. Mean year 3 scores 89(67-100)%. Year 2 to 3 difference was significant P¼0.02. Only 6(50%) patients scored higher each year, 8(67)% improved between year 1 and 2, and 10(83%) between year 2 and 3. There were 36 complications, mean per patient 3(1-8). CRBSI accounted for 18(50%), local infection 7(19%), occlusion 2(6%), and fracture 9(25%). Complications were correctly identified by 6(50%) patients. CRBSI was the most commonly missed with 4(33%) patients not recognising signs, despite answering the question correctly, 2 patients (the lowest scoring) missed signs of CRBSI on two occasions. While there was a statistical difference in the year 2 and year 3 scores, it is not possible to say whether this was due to increased knowledge or the format of the questions. While patients correctly identified local infections and occlusion, CRBSI was not always recognised, even on subsequent presentations, suggesting the need for a validated assessment tool.

Parenteral nutrition: How do patients initiated in the intensive care unit differ from those on the ward?

“…The frequency of monitoring is higher in ICU and thus the rate of biochemical events may also reflect this systematic bias. The absence of CLABSI in this study is consistent with low published rates of less than 1% in ward patients and less than 2% in ICU patients receiving PN [10,11].…”