title: Use of triple-lumen subclavian catheters for administration of total parenteral nutrition.
abstract: This study evaluated the safety of triple vs single-lumen catheters in intravenous nutrition. Patients who were judged likely to benefit from a triple-lumen catheter were randomized to receive either a single-lumen catheter, with additional peripheral or central venous access as needed, or a triple-lumen catheter. All patients were at increased risk of catheter-related infection because of one or more of the following conditions: > 60 years of age, breakdown of skin integrity, severe underlying illness, diagnosis of acute pancreatitis, recent head or neck surgery, or presence of a preexisting infection. Patients were excluded who had neutropenia, were immunosuppressed, had body burns > 40%, or had contaminated wounds in the subclavicular area. Of 204 patients entered between June 1989 and November 1991, 177 completed the required > or = 7 days of therapy. Seventy-eight of these patients were randomized to a single-lumen catheter and 99 to a triple-lumen catheter. Catheters were inserted and maintained by the Nutrition Support Team. Dressings were monitored daily and changed weekly using a bio-occlusive dressing. When parameters were met for a possible septic episode, simultaneous peripheral and central catheter blood cultures were obtained using the Isolator method. Catheter-related sepsis was considered present if the colony count from a central catheter lumen was > or = 5 times that of the peripheral blood. The incidence of catheter-related sepsis for single-lumen catheters was 2.6% (2 of 78) compared with 13.1% for triple-lumen catheters (13 of 99) (p < .01). No correlation was found with the number of insertion attempts, catheter days, or patient's age.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: N
authors.initials: N
authors.lastname: Clark-Christoff
authors.forename: V A
authors.initials: VA
authors.lastname: Watters
authors.forename: W
authors.initials: W
authors.lastname: Sparks
authors.forename: P
authors.initials: P
authors.lastname: Snyder
authors.forename: J P
authors.initials: JP
authors.lastname: Grant
mesh_terms: D001424:Bacterial Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000209:etiology; D004866:Equipment Contamination; D005069:Evaluation Studies as Topic; D006801:Humans; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D012307:Risk Factors; D013997:Time Factors