title: A prospective study of catheter-related complications in HPN patients.
abstract: OBJECTIVE
  Central venous access device (CVAD)-related complications such as catheter-related sepsis, occlusion and breakage contribute to both mortality and morbidity in home parenteral nutrition (HPN) patients. Prospectively collected data in these patients are scarce.
  
  
  METHODS
  Data on all CVAD-related complications in four tertiary referral centres in Australia and New Zealand were prospectively collected between 01/01/2009 and 31/12/2009 together with costs of each episode that required admission.
  
  
  RESULTS
  Of 53 patients (42 adults and 11 children), 27 suffered a total of 49 episodes of CVAD-associated complications (line infection 36, catheter blockage 5, line fracture 1, line migration 7), giving an incidence of 3.6 per 1000 CVAD days (11.6 per 1000 in patients with a multi-use CVAD). Thirty seven episodes resulted in hospital admission for a median duration of 8 days (range 1-29). Responsible microbes were mainly enteric with klebsiella being the most commonly isolated organism (10 episodes). The average cost of care per episode of CVAD-associated complication requiring inpatient admission was $A9,710 (€6480 approximately).
  
  
  CONCLUSIONS
  CVAD complications, in particular line infection are still a major source of potentially avoidable HPN morbidity and mortality with a high cost to the healthcare system. The predominance of enteric organisms in our series raises the possibility of bacterial translocation as a significant component of the pathogenesis of line sepsis in HPN patients.
authors.affiliation: Auckland City Hospital, Private Bag 92024, Auckland, New Zealand. lyng@adhb.govt.nz
authors.forename: Lyn
authors.initials: L
authors.lastname: Gillanders
authors.forename: Katherina
authors.initials: K
authors.lastname: Angstmann
authors.forename: Patrick
authors.initials: P
authors.lastname: Ball
authors.forename: Margie
authors.initials: M
authors.lastname: O'Callaghan
authors.forename: Andrew
authors.initials: A
authors.lastname: Thomson
authors.forename: Theodoric
authors.initials: T
authors.lastname: Wong
authors.forename: Mark
authors.initials: M
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D055815:Young Adult