The introduction of a nutrition clinical nurse specialist results in a reduction in the rate of catheter sepsis
ABSTRACT Catheter-related sepsis remains the major confounding factor in the long-term delivery of TPN. Previous studies have shown that the introduction of clinical nurse specialists (CNS) can lead to a reduction in sepsis from TPN catheters. This retrospective study aimed to determine the impact of a nutrition CNS on the rate of catheter-related sepsis. Furthermore, the cost of providing such a service was examined to see if it was offset from the savings obtained from reducing venous access infection.
Prior to the employment of a nutrition CNS, the total number of septic catheter complications were retrospectively collected over a 12-month period. Following appointment of the CNS, all patients requiring TPN were prospectively studied for signs of catheter-related sepsis and the data collected over a 4-year period.
The overall sepsis rate (cumulative percentage) fell significantly in the 4-year period after the nutrition CNS was appointed, from 52% to 2.3%. The reduction in venous catheter access was accompanied by a decrease in cost related to wastage of TPN and insertion of new Hickman lines.
The role of the CNS is primarily to improve the quality of care provided, but also to provide cost effectiveness. We have demonstrated that in addition to reducing infection rate of central venous catheters; the cost of employing a nutrition CNS is almost completely covered by the savings resulting from the reduction in wasted central venous catheters, TPN and operating time.
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ABSTRACT: Patients on home parenteral nutrition (HPN) are at high risk of central venous catheter sepsis (CVCS). CVCS can be associated with distant bacterial seeding. However, few cases of vertebral osteomyelitis (VO) related to HPN have been reported. For this reason, we made the hypothesis that the incidence of VO in patients on HPN is probably higher than what is reported. The goal of this study was to evaluate the incidence of infectious complications, and more specifically, the incidence of VO in patients on HPN.Journal of Clinical Medicine Research 08/2014; 6(4):272-7. DOI:10.14740/jocmr1825w
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ABSTRACT: Catheter-related bloodstream infections are a serious and common complication in patients receiving home parenteral nutrition (HPN). Prevalence of infections, type of agents, and effectiveness of antibiotic therapy were evaluated in 296 patients (133 males, 163 females; mean age 58.2 +/- 13.5 years) receiving HPN for at least 3 months, from January 1995 to December 2006. Patients underwent 99,969 (331 +/- 552; minimum 91, maximum 4353) days of catheterization, corresponding to 93,236 (311 +/- 489; minimum 52, maximum 4353) days of HPN. Fifty-two patients (24 males and 28 females; 35 oncological and 17 nononcological) were diagnosed with 169 infections. The overall corresponding infection rate was 2.0 per 1000 days of catheterization, with a progressive, regular decrease with time. In 30 cases, immediate central venous catheter removal was necessary. Infections were eradicated in 103 of 139 (74%) cases. As to the most common causative agent, 86 (51%) infections were due to Staphylococcus epidermidis. Of these, 64 were treated from 1995 to 2004, 57 of them (89%) successfully; 22 were treated from 2005 onward, only 7 of them (32%) successfully. Although the global infection rate has progressively decreased over the years, S epidermidis has shown an alarming increase in resistance to antibiotic treatment in the last 2 years, suggesting the need for strategies to prevent central venous catheter infection.Journal of Parenteral and Enteral Nutrition 05/2010; 34(3):254-62. DOI:10.1177/0148607110362900 · 3.14 Impact Factor
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ABSTRACT: Conclusions Comme pour tout traitement et toute nutrition artificielle, une information du patient sur les buts, les modalités, les bénéfices escomptés et les risques de la NP est indispensable. L’efficacité et la tolérance de la NP dépendent de la pertinence de l’indication, du choix raisonné du mélange nutritif prescrit et de la rigueur des procédures d’administration et de surveillance. Les mélanges industriels en poche à chambres multiples supplémentés en fonction des besoins spécifiques de chaque patient, notamment en vitamines et en oligoéléments, permettent de satisfaire les besoins nutritionnels, à court terme ou à moyen terme, de la majorité des patients adultes. Une NP plus spécifique ou prolongée impose une prise en charge spécialisée avec, éventuellement, la prescription de mélanges «à la carte». Le concours d’une équipe de support nutritionnel pour l’élaboration des protocoles, des procédures et des fiches techniques ainsi que pour la prise en charge des patients instables, ayant des besoins nutritionnels spécifiques ou de longue durée est un atout incontestable.Acta Endoscopica 02/2007; 37(S1). DOI:10.1007/BF02961833 · 0.16 Impact Factor