CENTRAL LINE OCCLUSION WITH 3-IN-1 NUTRITION ADMIXTURES ADMINISTERED AT HOME

The use of single-container parenteral nutrition admixtures can be cos t effective and can simplify home administration. Three-in-one admixtu res (dextrose, amino acids, lipid emulsion, and other additives in a s ingle bag) were in use when a marked increase in catheter occlusions w as seen in the pediatric home parenteral nutrition population. Insolub le laminar deposits were found in the removed catheters. In all subseq uently placed catheters, separate (SPLIT) infusions of lipid and paren teral nutrition solution were used rather than three-in-one admixtures . This was associated with an obvious decrease in catheter occlusions. Catheter life-span was retrospectively determined for 15 catheters of identical size and style that were used in eight patients who had rec eived either infusions of three-in-one admixtures or SPLIT infusions. Life table survival analysis revealed a median survival time of 70 day s for the three-in-one group (n = 8) and 290 days for the SPLIT group (n = 7). Survival distributions for the two groups were significantly different (p = .025). During the period of clustered catheter occlusio n, the use of three-in-one admixtures that were stored in the home for up to 7 days was associated with a shortened catheter life-span. Occl usion or deposit development was not seen in catheters used for inpati ent parenteral nutrition support when admixtures were prepared and inf used within 28 hours. Catheter deposits were implicated as sanctuary s ites for pathogenic bacteria in two patients. Failure to retrieve and inspect occluded catheters delayed the identification of the deposits. All occluded nutrition support catheters that cannot be cleared by st andard methods should be retrieved for inspection of the lumen as part of routine surveillance.