In situ bacteriologic diagnosis of total parenteral nutrition catheter infection.

An evaluation of the in situ bacteriologic status of a total parenteral nutrition (TPN) catheter, when the patient is pyretic but the cause of infection is not obvious, permits continued use of the catheter if the result is negative, as opposed to removal of the suspected catheter. To find a predictive value for the infection of the catheter, semiquantitative blood cultures taken through the TPN catheter were examined during the pyretic episodes. A total of 227 catheters from 204 patients were studied. Of these 149 were investigated during pyretic episodes. Twenty TPN catheters were removed because their semiquantitative blood cultures were positive, and in all cases the clinical conditions of the patients improved after removal of the catheters. The remaining 129 catheters investigated showed negative results and had predictive values of 100%. These catheters were left in place and all subsequently proved to be sterile on their removal at the end of the TPN. Thus 87% of the 149 suspected catheters were saved.