SEPSIS DURING TOTAL PARENTERAL-NUTRITION - EXPLORATION OF RISK-FACTORS AND DETERMINATION OF THE EFFECTIVENESS OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS

Background. Sepsis is the most frequent serious complication during to tal parenteral nutrition (TPN), resulting in increased morbidity, mort ality and health care costs, Existing reports have not documented the risk factors of sepsis during TPN, The objectives of this study were t o determine the rate of sepsis in our practice and to explore the risk factors for sepsis during TPN, We also determined the role and effica cy of using peripherally inserted central venous catheters (PCVC) as i nsertion catheters to administer TPN, Methods, From October, 1994, to May, 1996, we administered TPN to 378 pediatric patients hospitalized at Mackay Memorial Hospital, We followed all cases for the occurrences of any complications while administering TPN, We studied all patients who had fever, a clinical presentation of sepsis and a positive blood culture during their course of TPN, Results, During the 20-month peri od 378 patients received TPN for a total of 6562 days, Fifty-six patie nts presented with clinical sepsis and positive blood cultures, Signif icant features in the sepsis group included longer duration of TPN, ag e <3 months, usage of central venous catheters, gastrointestinal disea ses as indication for TPN, low birth weight and short gestational age in prematurity, Seven patients died despite prompt antimicrobial thera py, One hundred eleven patients received TPN via PCVC for a mean durat ion of 17.1 days, significantly longer than 10.4 days in the periphera l intravenous catheter group but no difference between the sepsis rate s, Conclusion, Considering the high incidence of sepsis during TPN, ev ery attempt should be made to minimize the length of TPN therapy and e ncourage early enteral feeding, We also recommend the use of PCVC in p atients requiring prolonged nutritional support.