Impact of a New Guideline for Central Venous Catheter Care on Sepsis in Total Parenteral Nutrition: Experience in Ramathibodi Hospital
Chulaporn Roongpisuthipong MD, ABN*, Vittanee Getupook MS*, Busba Chindavijak PhD***
Affiliation : * Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University ** Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University *** Faculty of Pharmacy, Ramathibodi Hospital, Mahidol University
Background : Total parenteral nutrition (TPN) is the essential treatment for hospitalized patients in whom
normal enteral nutrition is inadequate or not feasible. However, TPN-related sepsis is the most serious and
fatal complication of the treatment and the catheter is the most common cause of infection. Therefore, the
Nutrition Support team in Ramathibodi Hospital has developed a new guideline for central venous catheter
care for TPN patients and has used it for at least a year.
Objective : Survey the current incidence of TPN-related sepsis in the hospital, the predisposing factors of the
TPN-related sepsis, and the pathogenic organisms of the sepsis.
Materials and Methods : Between July 1999 and February 2000, 52 TPN treatments (catheter count) in 40
surgical and medical patients were prospectively recruited. Microbiological studies were done in all cases of
TPN-related sepsis.
Results : The incidence of TPN-related sepsis was 15% per catheter or 12.64/1000 catheter-days. Although no
statistically significant predisposing factors were found for the sepsis, some factors such as postoperative TPN
and short interval (< 2 days) for TPN line change (OR = 3.33, 95% CI = 0.33-30.34) showed a higher risk for
TPN-related sepsis. The most common pathogenic organisms were Coagulase-negative staphylococci, Can-
dida albicans, and gram-negative bacteria. The organisms were found from hemoculture in septic patients
and were well correlated with those found in the catheter line. Thus, the significant pathogenic role of
Coagulase-negative staphylococci emphasizes the importance of aseptic technique during catheterization.
Conclusion : The Ramathibodi guideline rendered support for a good policy to improve and standardize the
TPN treatment. Along with a practical guideline, the well-trained and highly responsible personnel would
also be crucial to avoid the infectious complications.
Keywords : Guideline, TPN-related, Catheter
