A randomized trial of 72-versus 24-hour intravenous tubing set changes in newborns receiving lipid therapy

被引:35
作者
Matlow, AG
Kitai, I
Kirpalani, H
Chapman, NH
Corey, M
Perlman, M
Pencharz, P
Jewell, S
Phillips-Gordon, C
Summerbell, R
Ford-Jones, L
机构
[1] Hosp Sick Children, Div Microbiol, Dept Pediat Lab Med, Toronto, ON M5G 1X8, Canada
[2] Hosp Sick Children, Dept Pediat, Toronto, ON M5G 1X8, Canada
[3] Hosp Sick Children, Dept Neonatol, Toronto, ON M5G 1X8, Canada
[4] Hosp Sick Children, Dept Biostat, Toronto, ON M5G 1X8, Canada
[5] Hosp Sick Children, Dept Nursing, Toronto, ON M5G 1X8, Canada
[6] Univ Toronto, Dept Pediat, Toronto, ON, Canada
[7] Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada
[8] Univ Toronto, Dept Publ Hlth Sci, Toronto, ON, Canada
[9] Minist Hlth, Lab Serv Branch, Toronto, ON, Canada
关键词
D O I
10.1086/501657
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
OBJECTIVE: To compare the microbial contamination rate of infusate in the intravenous tubing of newborns receiving lipid therapy, replacing the intravenous delivery system at 72-hour versus 24-hour intervals. DESIGN: Infants requiring intravenous lipid therapy were randomly assigned to have intravenous sets changed on a 72 or a 24-hour schedule, in a 3:1 ratio, in order to compare the infusate contamination rates in an equivalent number of tubing sets. SETTING: A 35-bed, teaching, referral, neonatal intensive-care unit (NICU). PARTICIPANTS: All neonates admitted to the NICU for whom intravenous lipid was ordered. METHODS: Patients were randomized in pharmacy, on receipt of the order for intravenous lipid therapy, to either 72- or 24-hour administration set changes, and followed until 1 week after discontinuation of lipids or discharge from the NICU. Microbial contamination of the infusate was assessed in both groups at the time of administration set changes. Contamination rates were analyzed separately for the lipid and amino acid-glucose tubing sets. Patient charts were reviewed for clinical and epidemiological data, including birth weight, gestational age, gender, age at start of lipid therapy, duration of parenteral nutrition, and type of intravenous access. RESULTS: During the study period, 1,101 and 1,112 sets were sampled in the 72- and 24-hour groups, respectively. Microbial contamination rates were higher in the 72-hour group than the 24-hour group for lipid infusions (39/1,101 [3.54%] vs 15/1,112 [1.35%]; P=.001) and for amino acid infusions (12/1,093 [1.10%] vs 4/1,103 [0.36%]; P=.076). Logistic regression analysis controlling for;birth weight, gestational age, and type of venous access showed that only the tubing change interval was significantly associated with lipid set contaminations (odds ratio, 2.69; P=.0013). The rate of blood cultures ordered was higher in the 72-versus the 24-hour group (6.11 vs 4.99 per 100 patient days of total parenteral nutrition; P=.017), and a higher proportion of infants randomized to the 72-hour group died (8% vs 4%; P=.05), although the excess deaths could not clearly be attributed to bacteremia. CONCLUSION: Microbial contamination of infusion sets is significantly more frequent with 72- than with 24-hour set changes in neonates receiving lipid solutions. This may be associated with an increased mortality rate.
引用
收藏
页码:487 / 493
页数:7
相关论文
共 17 条
[1]  
[Anonymous], 1991, MANUAL CLIN MICROBIO
[2]   SAFETY OF CHANGING INTRAVENOUS DELIVERY SYSTEMS AT LONGER THAN 24-HOUR INTERVALS [J].
BAND, JD ;
MAKI, DG .
ANNALS OF INTERNAL MEDICINE, 1979, 91 (02) :173-178
[3]   CONTAMINATION OF INTRAVENOUS-INFUSION FLUID - EFFECTS OF CHANGING ADMINISTRATION SETS [J].
BUXTON, AE ;
HIGHSMITH, AK ;
GARNER, JS ;
WEST, CM ;
STAMM, WE ;
DIXON, RE ;
MCGOWAN, JE .
ANNALS OF INTERNAL MEDICINE, 1979, 90 (05) :764-768
[4]   ASSOCIATION OF INTRAVENOUS LIPID EMULSION AND COAGULASE-NEGATIVE STAPHYLOCOCCAL BACTEREMIA IN NEONATAL INTENSIVE-CARE UNITS [J].
FREEMAN, J ;
GOLDMANN, DA ;
SMITH, NE ;
SIDEBOTTOM, DG ;
EPSTEIN, MF ;
PLATT, R .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 323 (05) :301-308
[5]   INTRAVENOUS TUBING WITH BURETS CAN BE SAFELY CHANGED AT 48-HOUR INTERVALS [J].
GORBEA, HF ;
SNYDMAN, DR ;
DELANEY, A ;
STOCKMAN, J ;
MARTIN, WJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1984, 251 (16) :2112-2115
[6]   THE RELATIONSHIP BETWEEN INTRAVENOUS FLUID CONTAMINATION AND THE FREQUENCY OF TUBING REPLACEMENT [J].
JOSEPHSON, A ;
GOMBERT, ME ;
SIERRA, MF ;
KARANFIL, LV ;
TANSINO, GF .
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 1985, 6 (09) :367-370
[7]  
LINARES J, 1985, J CLIN MICROBIOL, V21, P357
[8]   PROSPECTIVE-STUDY OF REPLACING ADMINISTRATION SETS FOR INTRAVENOUS THERAPY AT 48-HOUR VS 72-HOUR INTERVALS - 72 HOURS IS SAFE AND COST-EFFECTIVE [J].
MAKI, DG ;
BOTTICELLI, JT ;
LEROY, ML ;
THIELKE, TS .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1987, 258 (13) :1777-1781
[9]   NATIONWIDE EPIDEMIC OF SEPTICEMIA CAUSED BY CONTAMINATED INTRAVENOUS PRODUCTS .1. EPIDEMIOLOGIC AND CLINICAL FEATURES [J].
MAKI, DG ;
RHAME, FS ;
MACKEL, DC ;
BENNETT, JV .
AMERICAN JOURNAL OF MEDICINE, 1976, 60 (04) :471-485
[10]   HUMAN INFECTIONS DUE TO MALASSEZIA SPP [J].
MARCON, MJ ;
POWELL, DA .
CLINICAL MICROBIOLOGY REVIEWS, 1992, 5 (02) :101-119