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Chapter 073. Enteral and Parenteral Nutrition (Part 11)

Infectious Infections of the central access catheter rarely occur in the first 72 h. Fever during this period is usually from infection elsewhere or another cause. Fever that develops during PN can be addressed by checking the catheter site and, if the site looks clean, exchanging the catheter over a wire with cultures taken through the catheter and at the catheter tip. If these cultures are negative, as they are most of the time, the new catheter can continue to be used. If a culture is positive for a relatively nonpathogenic bacteria like Staphylococcus epidermidis, consider a second exchange over. | Chapter 073. Enteral and Parenteral Nutrition Part 11 Infectious Infections of the central access catheter rarely occur in the first 72 h. Fever during this period is usually from infection elsewhere or another cause. Fever that develops during PN can be addressed by checking the catheter site and if the site looks clean exchanging the catheter over a wire with cultures taken through the catheter and at the catheter tip. If these cultures are negative as they are most of the time the new catheter can continue to be used. If a culture is positive for a relatively nonpathogenic bacteria like Staphylococcus epidermidis consider a second exchange over a wire with repeat cultures or replace the catheter depending on the clinical circumstances. If cultures are positive for more pathogenic bacteria or for fungi like Candida albicans it is generally best to replace the catheter at a new site. Whether antibiotic treatment is required is a clinical decision but C. albicans grown from the blood culture in a patient receiving PN should always be treated because the consequences of failure to treat can be dire. Catheter infections can be minimized by dedicating the feeding catheter to PN without blood sampling or medication administration. Central catheter infections are a serious complication with an attributed mortality of 12-25 . Infections in central venous catheters dedicated to feeding should occur less frequently than 3 per 1000 catheter-days. Home PN catheters that become infected may be treated through the catheter without removal of the catheter particularly if the offending organism is S. epidermidis. Clearing of the biofilm and fibrin sheath by local treatment of the catheter with indwelling alteplase may increase the likelihood of eradication. Antibiotic lock therapy with high concentrations of antibiotic with or without heparin in addition to systemic therapy may improve efficacy. Sepsis with hypotension should precipitate catheter removal in either the temporary