Effect of the mode of lipid administration on parenteral nutrition-related infections

OBJECTIVE: To determine if total nutrient admixtures (TNAs) influence the rate of infection in clinical practice. DESIGN: Prospective, randomized trial. SETTING: Department of Veterans Affairs Medical Center. PATIENTS: All patients were administered parenteral nutrition (PN) via a central venous catheter and received daily lipids. INTERVENTION: Patients were randomized as to the mode of administration of lipids. Lipids were either administered with other PN components in a TNA or were piggybacked (PB) into the PN solution. MAIN OUTCOME MEASURES: Treatment groups were compared for the rate of occurrence of PN-related infections. Infections were classified as catheter infections or catheter sepsis. RESULTS: Ninety-eight patients were entered into the trial. Data from 96 patients (44 TNA, 52 PB) were available for analysis. Treatment groups were well matched for age, baseline albumin, days of PN, predicted basal metabolic rate, and calorie and protein requirements. TNA patients received a significantly greater percentage of nonprotein calories as lipid. The incidence of infection was 12.6 and 10.3 per 1000 days of PN in the TNA and PB groups, respectively (p = 0.89). The microorganisms responsible for infection and the type of infections that developed were similar in both groups. CONCLUSIONS: Use of TNAs does not influence the rate of infection in patients receiving PN.

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