A prospective study of catheter-related complications in HPN patients
A prospective study of catheter-related complications in HPN patients
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DOI：
10.1016/j.clnu.2011.09.009
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发表时间：
2012-02-01
影响因子：
6.3
通讯作者：
Thomas, Mark
中科院分区：
文献类型：
--
作者：
Gillanders, Lyn;Angstmann, Katherina;Thomas, Mark
背景和目标：中心静脉通路装置（CVAD）相关并发症，如导管相关败血症、闭塞和断裂，导致家庭肠外营养（HPN）患者的死亡率和发病率。在这些patients.Methods：所有CVAD相关并发症的数据在澳大利亚和新西兰的四个三级转诊中心前瞻性收集在01/01/2009和31/12/2009之间的费用，每个事件，需要入院。结果：53例（42名成人和11名儿童），27名患者共发生49次CVAD相关并发症（管路感染36例，导管堵塞5例，管路断裂1例，管路移位7例），发生率为3.6/1000 CVAD日（多次使用CVAD的患者为11.6/1000）。37次发作导致住院，中位持续时间为8天（范围1-29）。负责的微生物主要是肠道，克雷伯氏菌是最常见的分离微生物（10次发作）。需要住院治疗的CVAD相关并发症每次发作的平均护理费用为A9，710美元（（原文如此）约6480美元）。结论：CVAD并发症，特别是管路感染仍然是潜在可避免的HPN发病率和死亡率的主要来源，对医疗保健系统来说成本很高。在我们的研究中，肠道微生物占优势，这增加了细菌移位作为HPN患者败血症发病机制的重要组成部分的可能性。(C)2011年爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Background & aims: 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 ((sic)6480 approximately).Conclusion: 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. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.