A Randomized Trial on the Effect of Tubing Changes on Hub Contamination and Catheter Sepsis during Parenteral Nutrition

Abstract

In previous studies the contamination of the catheter hub was found to be a common portal of entry for bacteria causing catheter-related sepsis. Since hub manipulations during tubing changes may increase the risk of contamination, a prospective trial was conducted to find out the effects of the frequency of tubing replacements on hub colonization and catheter sepsis rates. The results were compared with those obtained during an outbreak of coagulase negative staphylococci septicemia. Fifty-two patients were randomly allocated into two groups. Group A (n = 20) had the line changes every 2 days while group B (n = 32) had it replaced every 4 days. When the catheter was removed, the catheter tip and the hub were cultured by a quantitative method. Sterile, colonized, or infected hubs were equally distributed in both groups (A: 80, 15, and 5% us B: 84, 6, and 10%). There were three episodes of catheter sepsis, one in group A and one in group B due to hub infection, and one in group B due to hematogenous seeding of the catheter tip. There were significant (p < 0.001) differences between the trial and the historic series in respect to rates of hub colonization infection (19 us 50%) and catheter sepsis (5.7 us 40%). Delaying tubing changes does not increase catheter sepsis or hub contamination rates and, together with adequate hub protection, has proved to be a valuable factor in controlling an outbreak of catheter sepsis due to the coagulase negative staphylococci. (Journal of Parenteral and Enteral Nutrition 9:322-325, 1985)