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What information should lead to a suspicion of catheter sepsis in HPN?
- Source :
- Clinical Nutrition. 27:552-556
- Publication Year :
- 2008
- Publisher :
- Elsevier BV, 2008.
-
Abstract
- Summary Background & aims The diagnosis of catheter sepsis in patients on home parenteral nutrition can be difficult and patients often do not present with classical symptoms of pyrexia whilst feeding. This study reviews the clinical and diagnostic criteria needed to diagnose catheter sepsis. Methods A retrospective consecutive notes review of 2 years of patients presenting with catheter infections assessed symptoms, inflammatory markers and some liver function tests. The same data was also collected on those same patients who had successfully under gone line salvage. The two sets were compared using the Mann–Whitney U-test and predictive calculations were carried out using receiver operated characteristic curves. Results Over the two year period there were 37 episodes of CRBSI in 31 patients recorded. Successful catheter salvage was achieved in 30 episodes (in 24 patients) which is an 81% salvage rate. The most significant abnormality seen was a raised C-reactive protein, but less than a third of patients had a raised white cell count. However, there were significant changes in the bilirubin (p = 0.0007) and albumin (p = 0.0013) in these patients. Almost a third of patients who feel unwell do not present with a raised temperature. Conclusions The diagnosis of CRBSI remains difficult, but it should be suspected in patients with newly abnormal CRP, albumin or bilirubin and in the non-specifically unwell patient a clinician should not be misled by a normal white cell count and apyrexia.
- Subjects :
- Catheterization, Central Venous
medicine.medical_specialty
medicine.medical_treatment
Critical Care and Intensive Care Medicine
Diagnosis, Differential
Sepsis
Leukocyte Count
Catheters, Indwelling
Liver Function Tests
Predictive Value of Tests
medicine
Humans
Serum Albumin
Retrospective Studies
Nutrition and Dietetics
medicine.diagnostic_test
business.industry
Bilirubin
Retrospective cohort study
medicine.disease
Surgery
Catheter
C-Reactive Protein
Parenteral nutrition
ROC Curve
Predictive value of tests
Bacteremia
Equipment Contamination
Parenteral Nutrition, Home
Liver function tests
business
Central venous catheter
Subjects
Details
- ISSN :
- 02615614
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- Clinical Nutrition
- Accession number :
- edsair.doi.dedup.....b7538513e56e23a6fefce50b1b3c419c