Triple lumen catheters for parenteral nutrition

We retrospectively reviewed the charts of 61 patients in whom a total of 101 triple lumen catheters (TLCs) were used for parenteral nutrition for a total of 1,512 days (mean 15 +/- 11 days). Patients were categorized as those having culture-negative TLC tips either with or without infection elsewhere (groups 1 and 2, respectively) and those with culture-positive TLC tips (group 3). Temperature, WBC, alkaline phosphatase value, and SGOT level were recorded one or two days before TLC removal (period 1) and one or two days or three to five days after TLC removal (periods 2 and 3, respectively). The incidence of catheter sepsis was 4%. Fourteen other tips were contaminated. Patients in group 1 remained afebrile during all three periods, and all tips removed were culture-negative. Removal of the TLC in groups 2 and 3 caused neither defervescence nor decreased WBC. We conclude that TLCs can be used for total parenteral nutrition with a low incidence of infection, that TLC tips need not be cultured in afebrile patients without other sources of infection, and that a TLC can be safely left in place so long as the patient is afebrile. However, the risk of infection or contamination is high for catheters left in place for more than two weeks.