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Single-lumen vs double-lumen catheters for total parenteral nutrition. A randomized, prospective trial
1Department of Veterans Affairs Medical Center, Long Beach, Calif.
Abstract:
Multilumen catheters have been condemned for hyperalimentation based on reports of infection rates between 10% and 25% in uncontrolled studies. Because of the potential usefulness of multilumen catheters, we studied infection rates in a prospective, randomized trial. All patients requiring total parenteral nutrition were randomized to either single- or double-lumen catheters. Single-lumen catheters were used for dextrose-amino acids only. Medications or fat emulsions were given either by another central line or peripherally. Double-lumen catheters were used for dextrose-amino acid solutions, compatible medications, and fat emulsions. Catheters were cultured (48 single lumen and 53 double lumen) from 112 patients who successfully completed the study. No patients in either group developed catheter sepsis. We concluded that parenteral nutrition can be given as safely via double-lumen catheters as single-lumen catheters when strict protocols are established and followed.
Insights
Double-lumen catheters are as safe as single-lumen catheters for total parenteral nutrition. Strict protocols ensure no increase in infection rates for hyperalimentation, making these central venous catheters a viable option.
Area of Science:
- Medical Devices
- Infectious Diseases
- Nutritional Support
Background:
- Multilumen catheters previously associated with high infection rates (10-25%) in hyperalimentation.
- Previous studies were uncontrolled, raising questions about catheter safety.
- Potential benefits of multilumen catheters warrant further investigation.
Purpose of the Study:
- To prospectively evaluate and compare infection rates between single- and double-lumen catheters for total parenteral nutrition.
- To determine if double-lumen catheters can be used safely for hyperalimentation under strict protocols.
Main Methods:
- Prospective, randomized trial comparing single- and double-lumen central venous catheters.
- Patients requiring total parenteral nutrition were randomized to catheter type.
- Catheters were cultured post-study to assess for infection.
Main Results:
- No catheter sepsis occurred in either the single-lumen or double-lumen catheter groups.
- 112 patients completed the study with 48 single-lumen and 53 double-lumen catheters cultured.
- Infection rates were comparable between the two groups when strict protocols were followed.
Conclusions:
- Total parenteral nutrition can be administered as safely using double-lumen catheters as with single-lumen catheters.
- Implementation of strict protocols is crucial for safe use of multilumen catheters.
- Double-lumen catheters are a safe option for hyperalimentation when guidelines are adhered to.