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Catheter-related bloodstream infections in palliative care patients receiving parenteral nutrition by medical home care
  1. Anna Schedin1,
  2. Charlotte Goodrose-Flores2,
  3. Stephanie Bonn2 and
  4. Linda Björkhem-Bergman3,4
  1. 1Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö, Sweden
  2. 2Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Stockholm County, Sweden
  3. 3Palliative Home Care and Hospice Ward, Stockholms Sjukhem, Stockholm, Sweden
  4. 4Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
  1. Correspondence to Dr Linda Björkhem-Bergman, Palliative Home Care and Hospice Ward, Stockholms Sjukhem, Stockholm, Sweden; linda.bjorkhem-bergman{at}ki.se

Abstract

Background Catheter-related bloodstream infections (CRBSIs) constitute a major complication associated with the use of central venous lines (CVL). The aim of this study was to investigate the incidence proportion and risk factors of CRSBI in palliative care patients with CVL receiving home parenteral nutrition (HPN).

Methods Medical records from patients admitted to a medical home care unit in stockholm, Sweden, during 2017 were reviewed (n=1022) and 454 palliative care patients with a CVL were identified. Data on CRBSI cases, HPN exposure time, type of parenteral nutrition (PN), age, diagnosis and type of CVL were collected.

Results Twenty-nine of 143 patients receiving HPN through a CVL were diagnosed with a CRBSI (20%). Nine of 311 patients with CVL without exposure for HPN developed CRBSI (3%). The risk of a CRBSI was significantly higher in patients receiving HPN compared with those not receiving HPN, OR 8.5 (95% CI 4.0 to 18.7). For those receiving HPN six to seven times a week the risk was even higher, OR 13 (95% CI 5.1 to 30.3). The highest incidence proportion of CRBSI (31%) was found in a home care team where patients had been trained to disconnect themselves from the PN drip. Sex, cancer versus non-cancer, type of CVL or protein content in the PN, did not differ between patients that developed CRBSI versus those that did not develop the outcome.

Conclusion HPN entails a high risk of CRBSI. A high frequency of PN and incautious handling of the disconnection of the drip, seem to be the most important risk factors.

  • home care
  • cachexia
  • drug administration
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Footnotes

  • Contributors AS and LB-B contributed to the conception and design of the research. AS, CG-F, SB and LB-B contributed to the acquisition, analysis and interpretation of the data. AS and LB-B drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and have read and approved the final manuscript.

  • Funding This study was financially supported by grants from Stockholm County Council (ALF 20160036 and 20180320), the Swedish Cancer Society (CAN 2017/233 and CAN 2018/316), Stockholms Sjukhems Jubileumsfond and ASIH Stockholm Södra. The funding bodies did not have any role in the design of the study and collection, analysis and interpretation of data and in writing of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Central Ethical Committee in Sweden, Dnr 2019/01110, in compliance with the 1964 World Medical Association’s Declaration of Helsinki and the 1975 Tokyo Amendment.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available from the corresponding author upon reasonable request.

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