Techniques, Materials, and Devices Prevention of Catheter-Related Sepsis During Parenteral Nutrition: Effect of a NeW Connection Device YOSHIFUMI INOUE, MD*; RIICHIRO NEZU, MD*; HIKARU MATSUDA, MD*; MAKOTO FUJII, MD†; SUMIO NAKAI, MD†; MASAFUMI WASA, MD†; YOJI TAKAGI, MD†; AND AKIRA OKADA, MD† From the *First

Department of Surgery and the †Department of Pediatric Surgery, Osaka University Medical School, Japan

ABSTRACT. A prospective study was carried out to determine the clinical effect of a newly devised catheter connection method (I system) and piggyback access system. Previous studies have demonstrated that the I system avoided bacterial contamination in vitro during tubing change that Luer-Lock connectors did not. The purpose of this study was to investigate the ability of this device coupled with a new closed-system piggyback technique for multipurpose access to reduce catheterrelated sepsis in clinical practice. Two hundred and thirty patients receiving total parenteral nutrition were divided into two groups. Group I (n = 106) used the I system connector and group L (n 124) used a Luer-Lock connector. Catheters in =

During the last two decades marked advancements have been made in the field of total parenteral nutrition (TPN), and the technique is now widely applied in clinical practice. Catheter-related sepsis (CRS), however, still represents an important complication of TPN therapy.

The pathogenesis of CRS is multifactorial, including contamination of the infusion solution, contamination at the connection site between catheter hub and infusion line,’ contamination from the cutaneous entry of the skin,’ and contamination from endogenous colonization of the catheter.’ In this study we evaluated the hypothesis that bacterial contamination at the connection site between catheter hub and the infusion line is a major cause of CRS.’ We have previously reported potential contamination of the hub with the Luer-Lock connector.6 In an in vitro study, we subsequently reported a significant reduction in hub contamination using a new connection device named the I system. We now report on a modification of the device allowing multiple closed access, avoiding the use of stopcocks. The purpose of this study is to examine the effectiveness of this new system in reducing CRS during the clinical application of TPN. MATERIALS AND METHODS

The I System The I system consists of an I plug (a cap with a latex end injection plug with a male screw) and an I set (a

both groups were used for multipurpose access for infusion and blood sampling. In group L, a three-way stopcock and/or piggyback system was used for multiple access. In group I, a newly designed closed-system piggyback was used. The incidence of

sepsis was significantly lower in group I (1.89%/catheter) than in group L (12.10%/catheter) (p < .01, 2 analysis), and the average duration of use of each catheter χ was significantly longer in group I than in Group L (p

Prevention of catheter-related sepsis during parenteral nutrition: effect of a new connection device.

A prospective study was carried out to determine the clinical effect of a newly devised catheter connection method (I system) and piggyback access sys...
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