Use of Triple‐Lumen Subclavian Catheters for Administration of Total Parenteral Nutrition

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Abstract
This study evaluated the safety of triple vs single‐lumen catheters in intravenous nutrition. Patients who were judged likely to benefit from a triple‐lumen catheter were randomized to receive either a single‐lumen catheter, with additional peripheral or central venous access as needed, or a triple‐lumen catheter. All patients were at increased risk of catheter‐related infection because of one or more of the following conditions: >60 years of age, breakdown of skin integrity, severe underlying illness, diagnosis of acute pancreatitis, recent head or neck surgery, or presence of a preexisting infection. Patients were excluded who had neutropenia, were immuno‐suppressed, had body burns >40%, or had contaminated wounds in the subclavicular area. Of 204 patients entered between June 1989 and November 1991, 177 completed the required ≥7 days of therapy. Seventy‐eight of these patients were randomized to a single‐lumen catheter and 99 to a triple‐lumen catheter. Catheters were inserted and maintained by the Nutrition Support Team. Dressings were monitored daily and changed weekly using a bio‐occlusive dressing. When parameters were met for a possible septic episode, simultaneous peripheral and central catheter blood cultures were obtained using the Isolator method. Catheter‐related sepsis was considered present if the colony count from a central catheter lumen was ≥5 times that of the peripheral blood. The incidence of catheter‐related sepsis for single‐lumen catheters was 2.6% (2 of 78) compared with 13.1% for triple‐lumen catheters (13 of 99) (p <.01). No correlation was found with the number of insertion attempts, catheter days, or patient's age. We conclude that triple‐lumen catheters should not be routinely used for intravenous nutrition because of an increased risk for central catheter‐related sepsis. (Journal of Parenteral and Enteral Nutrition 16: 403–407, 1992)