This article is more than 5 years old. Information may no longer be current.
Researchers rule out environmental factors in complications from home infusion therapy
Click Here to Manage Email Alerts
Complications and readmissions related to central venous catheters for home infusion therapy may be common but they are not associated with typical environmental exposures, according to a prospective cohort study published in Infection Control and Hospital Epidemiology.
“Our primary goal was to examine whether home environmental factors increased the [central venous catheter (CVC)] complication rate,” Trish M. Perl, MD, MSc, senior epidemiologist at Johns Hopkins Health System, and colleagues wrote. “No environmental exposures indicated were associated with CVC complications.”
More than 1.2 million courses of home infusion therapy are delivered annually in the United States, but the risks associated with CVC complications have not been a focus of research. Therefore, Perl and colleagues investigated the role of environmental and other risk factors in complications with CVCs for home infusion therapy.
They studied patients aged 18 years and older who were discharged from Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center from March to December 2015 with peripherally inserted central catheters or tunneled CVCs.
Of 368 patients who met eligibility criteria, 60.3% (n = 222) agreed to participate in the study, providing 11,928 CVC-days of data. Most patients were white (72.1%), privately insured (68%), received outpatient parenteral antimicrobial therapy (73.4%) and had peripherally inserted central catheters (65.3%).
Patients underwent chart abstraction and monthly telephone surveys that focused on complications and environmental factors, such as exposure to well water, uncooked meats, pets or soil. They remained in the study until 30 days after CVC removal.
The researchers used multivariable analyses to estimate odds ratios and adjusted incidence rate ratios between clinical, demographic and environmental risk factors and 30-day readmissions or CVC complications.
Overall, 52 patients (23.4%) had a CVC complication — a rate of 4.37 per 1,000 CVC-days. Sixty patients (27%) were readmitted within 30 days of hospital discharge, of whom 14 (23.3%) had readmissions related to a CVC complication.
According to the researchers, total parenteral nutrition was associated with increased 30-day readmissions (adjusted OR = 4.8; 95% CI, 1.51-15.21) and CVC complications (aIRR = 2.41; 95% CI, 1.09-5.33). Researchers explained that patients on TPN may be more likely to have central line-associated bloodstream infections, that TPN components may lead to increased CVC occlusions and that patients needing TPN may have more severe illnesses.
Contrary to the researchers’ expectations, environmental exposures were not associated with CVC complications, except for exposure to soil through gardening or yard work, which was associated with a decreased likelihood of readmissions (aOR = 0.09; 95% CI, 0.01-0.74). They were surprised by this finding but noted that, perhaps, patients capable of yard or garden work might have been healthier than other patients in the cohort.
Perl and colleagues wrote that the study supports the need to better benchmark CVC complications among home infusion patients.
“Traditional risk factors may play a larger role in complications than environmental risk factors,” they concluded. “More studies in home infusion therapy are needed to understand the frequency of complications and how to reduce them, particularly in high-risk subpopulations such as TPN patients.”– by Sarah Kennedy
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts