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.
"Central venous catheter-related sepsis (CVCS) is the most frequent infectious complication encountered in patients on HPN [1, 2, 4, 5]. The incidence rate of CVCS in patients on HPN is estimated to be between 3 and 6/1,000 days of central venous catheterization (CVC) [2, 4-7]. "
[Show abstract][Hide abstract] ABSTRACT: Background
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.
A retrospective study of all patients receiving HPN from 2001 to 2006 was conducted. Patients who received HPN for < 1 month were excluded. Infectious complications and, more specifically, cases of VO were searched.
Thirty-one patients received HPN and were included in the analysis. Forty-four infectious complications occurred (1.302/1,000 CVC-days). The most frequent infectious complication was urinary tract infection (25 cases; 0.740/1,000 CVC-days). Seven CVCS occurred in five different patients (0.207/1,000 CVC-days). In patients with CVCS, 42.9% (three cases) developed a secondary VO. No predictive factors for the development of VO could be identified in univariate analysis.
We report a very low rate of infectious complications and an even lower rate of CVCS in patients on HPN. However, we report that 42.9% of our cases of CVCS developed a secondary VO. Consequently, VO must be part of the differential diagnosis among patients with HPN who complain of back pain.
Journal of Clinical Medicine Research 08/2014; 6(4):272-7. DOI:10.14740/jocmr1825w
"To provide data to the boards of nursing to assist them in determining the level of regulation appropriate for NPs and CNSs USA Quantitative Electronic survey response rate 11% so postal version of survey conducted response rate 30% n = 1,529 NPs n= 1,344 CNSs (-) Response rate (+) Sample size (-) Non random sample Seymour et al., (2002) To examine the understandings and experiences of postholders in relation to the Macmillan Nurse role UK Grounded theory. Semi-structured interviews n=44 Macmillan Nurses and n=47 key colleagues (-) Multiple interviewers (+) Variety of sites (+) Sample size Scott (1999) To describe the roles, activities & skills of the clinical nurse specialist in the USA USA Descriptive study Postal survey n = 724 CNSs Subscribers to CNS journal (+) Sample size (+) Questionnaire pretested and used in pilot study twice (-) Purposive sample (+) Theoretical framework (+) Content validity addressed Sutton et al., (2005) "
[Show abstract][Hide abstract] ABSTRACT: Parenteral nutrition becomes necessary when the gastrointestinal tract has insufficient function as to afford sufficient fluid,
electrolyte and nutrient absorption. Indications for this therapy include prolonged postoperative ileus, prolonged intestinal
obstruction, short bowel syndrome, various malabsorptive disorders, proximal enteric fistulas for which an enteral feeding
tube cannot be placed distal to, severe acute pancreatitis and severe mucositis/esophagitis. Parenteral nutrition, although
typically delivered through a large central vein, can also be infused peripherally with special techniques. Rarely, intradialytic
parenteral nutrition is required. Parenteral nutrition includes macronutrients (protein in the form of a balanced, free amino
acid solution, carbohydrate in the form of a dextrose monohydrate and fat in the form of a lipid emulsion), fluid, electrolytes
(sodium, potassium, magnesium and acetate/chloride to adjust pH), minerals (calcium, phosphorous, iron in some individuals),
trace minerals (zinc, copper, selenium) and vitamins (water and fat-soluble). Numerous complications may develop as a result
of parenteral nutrition including mechanical issues related to the catheter for solution delivery or its insertion, that include
infection, occlusion (venous thrombosis or non-thrombotic occlusion), electrolyte disturbances and hyperglycemia, as well
as hepatic, renal, pulmonary, and bone complications. Therapy should be appropriately prescribed and rigorously monitored
for efficacy and safety.
The Australian nurses' journal 10/1980; 10(3):36-40.
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