Central line–associated bloodstream infections and complications in adult home parenteral nutrition: Observations from a quality improvement initiative

The literature is inconsistent regarding differences in infection risk between central venous catheter types used for home parenteral nutrition (HPN). Our goal was to determine if significant differences exist in rates of infection and other complications between peripherally inserted central catheters, tunneled central venous catheters, and implanted ports, as well as between single and multiple lumen catheters used for HPN. Data were collected for 141 central venous catheters placed in 89 adults receiving HPN provided by Continuum home health company affiliated with University of Virginia health system. The catheters were 63% peripherally inserted, 27% tunneled, and 10% implanted ports, with 25,273 total catheter days and 15,474 HPN days. Central line-associated bloodstream infection (CLABSI) rates were 0.91 episodes per 1000 total catheter days overall, 1.91 for peripherally inserted, 0.63 for tunneled, and zero for ports. CLABSI rates per 1000 HPN days were 1.49 overall, 2.61 for peripherally inserted, and 0.76 for tunneled catheters. CLABSI rates were significantly greater for peripherally inserted than for tunneled catheters per total (P = 0.023) and per HPN (P = 0.011) catheter days. CLABSI rates were greater, but not significantly so, for multiple than for single lumen catheters. The rate of noninfectious complications was not significantly different between tunneled and peripherally inserted central catheters and was zero for ports. HPN CLABSI rates were significantly lower with implanted ports and tunneled central venous catheters as compared with peripherally inserted central catheters.