Preventing Central Line-Associated Bloodstream Infections (CLABSI) in Patients Receiving TPN

TPN is a life-saving treatment for many patients who can’t consume food or drink by mouth. It allows them to receive the necessary nutrients the body needs to stay healthy and function properly. However, there’s a risk of complications, including central line-associated bloodstream infections (CLABSI).

CLABSI in patients receiving TPN can lead to prolonged hospital stays, higher healthcare costs, and even death. In fact, over 28,000 patients die from this complication annually. The good news is that most CLABSI events associated with TPN are preventable through established best practices and techniques.

This guide will show you how to prevent CLABSI by following proper guidelines and central line maintenance techniques.

Understanding TPN Therapy

Total parenteral nutrition, or TPN therapy, is a form of intravenous nutrition therapy that provides patients who can’t consume food or drink by mouth with all the essential nutrients their body needs to function.

Providers may prescribe TPN for cancer patients or those with gastrointestinal disorders, short bowel syndrome, and those recovering from surgery, among other conditions.

TPN typically includes micronutrients (e.g., minerals, vitamins, electrolytes) and macronutrients (e.g., proteins, fats, and carbohydrates). The patient’s health condition and blood test values will determine what’s in a TPN solution. The nutrients contained in the TPN solution will enter the patient’s bloodstream and support their vital functions.

Administering TPN

TPN is primarily administered through a central venous access device, which provides reliable vascular access for long-term nutritional support.

Nurses provide comprehensive training to patients and caregivers, enabling them to safely administer TPN at home while minimizing the risk of complications, including CLABSI and other infections.

Complications of TPN

TPN is associated with various complications. Metabolic complications of TPN include conditions like hyperglycemia (high blood sugar), electrolyte imbalance, refeeding syndrome, and liver dysfunction.

There is also the risk of non-metabolic complications that can be just as dangerous. One of these complications is CLABSI. Knowing how to prevent CLABSI can be the difference between life and death for a patient.

What Is CLABSI?

CLABSI, or central line-associated bloodstream infection, is when harmful pathogens like bacteria enter the patient’s bloodstream through a central line or catheter.

While this TPN complication can be a potentially life-threatening infection, following proper guidelines and central line maintenance techniques will minimize the risk for CLABSI and other infections.

Risk Factors for CLABSI in Patients Receiving TPN

Several risk factors that increase the likelihood of developing CLABSI while receiving TPN include:

• Improper catheter care technique
• Long hospital stays
• Weakened immune system
• Prolonged need for vascular access
• Improper aseptic technique during TPN administration
• Underlying medical conditions such as diabetes or cancer
• Concurrent use of other invasive devices, such as urinary catheters

Tips To Prevent CLABSI

Healthcare providers must implement the best practice recommendations during treatment administration to prevent CLABSI. Here are some measures you can take to reduce the risk of CLABSI:

Selection of Appropriate Devices

The first step to preventing CLABSI involves choosing the appropriate devices for TPN therapy. Healthcare professionals must assess each patient’s medical history and determine their needs based on their current symptoms.

The healthcare professional will assess the potential health risks associated with different types of central venous access devices and select the best one, depending on the potential for complications and the patient’s duration of therapy.

Site Selection

The second factor to consider to prevent CLABSI is to select a proper site for CVAD insertion. To determine the best site, the healthcare professional will assess the patient’s activity level, age, and the size of the CVAD.

The best practice is to choose the non-dominant side of the patient’s body for CVAD insertion. Choosing this side will reduce the risk of contamination from the patient’s hand and make them more comfortable.

Selecting the appropriate site can also reduce the risk of accidental dislodgement of the device and prevent complications such as hematoma, skin necrosis, and vascular damage.

Proper TPN Solution Preparation

The next factor that will help you prevent CLABSI is how you prepare the solution to infuse into the patient’s bloodstream. To prevent CLABSI, you must follow infection prevention protocols from the first step.

This means preparing the TPN solution in a clean environment, following the recommended aseptic techniques, and following strict personal hygiene protocols.

Regular Catheter Care and Line Maintenance

The most critical step for preventing CLABSI involves proper care and maintenance of central venous catheters.

If you want to learn how to prevent CLABSI by properly maintaining the line integrity, here are some measures you can take:

Change Line Dressings Routinely

The risk of CLABSI depends heavily on how often TPN tubing and site dressings are changed. Tubing for TPN administration are changed every 24 hours, usually with each new TPN bag. Routine dressing changes for the CVAD are necessary for reducing the risk of contamination and infection.

The CVAD dressing must be changed every 7 days or sooner if needed. It’s best to rely on the assigned nurse to perform scheduled dressing changes. Dressing changes are often scheduled in coordination with any lab draws that are required.

Although the dressing change is done in a clean environment, it is a sterile procedure. The nurse will need a proper setup area in order to lay out the sterile field supplies.

Inspect for Signs of Infection

Inspect the central venous catheter site daily for signs of infection, dislodgment, and blockage. If you notice any signs of these catheter issues, address the underlying problem immediately to help prevent further complications, then contact your pharmacy or nursing provider.

Don’t Disconnect CVADs

Whenever possible, avoid frequent disconnections of the TPN tubing from the catheter to maintain a closed system and reduce contamination risk. This means you must minimize the frequency of disconnecting and reconnecting the TPN tubing. If you disconnect the TPN tubing from the CVAD, make sure a  cap is placed on the end of the tubing to keep it clean. Clean the catheter with an alcohol pad before reconnecting the tubing.

CLABSI Detection

You must know the signs of CLABSI because early recognition and treatment can help the patient avoid potentially life-threatening complications.

If you notice any swelling, redness, fever, chills, or hypotension, the patient is most likely infected.

Your health care provider may order blood cultures to determine the most appropriate antibiotic treatment and then begin treatment immediately.

Education and Training

It’s essential that both healthcare professionals and patients are educated on ways to prevent CLABSI as well as CLABSI symptoms to watch out for.

Healthcare providers must receive ongoing education to learn the best practices for inserting and maintaining central venous catheters.

Patients must also receive education on the symptoms of CLABSI, proper care of the CVAD, and steps to take if they suspect an infection. 

Using Evidence-Based Guidelines

The pharmacy and nursing providers always use evidence-based guidelines and protocols. Education is provided to ensure patients and caregivers understand how to effectively prevent CLABSI during TPN therapy. The most reliable TPN troubleshooting guides are regularly updated to reflect the latest current practices. By following these established guidelines, you can minimize the risk of infection, prevent CLABSI during TPN administration, improve patient outcomes, and ensure successful treatment.

Special Considerations for High-Risk Patients

Lastly, special considerations and protocols must be in place for patients at a higher risk of CLABSI. For instance, people with compromised immune systems or underlying medical conditions are more prone to getting infected. 

These precautionary measures help ensure that high-risk patients can safely receive TPN while minimizing the risk of infection.

Receive Safe TPN Therapy at Home from AmeriPharma® Specialty Pharmacy

Preventing CLABSI with TPN requires a comprehensive approach by healthcare professionals. They must know the latest protocols and implement the best practices to reduce the risk of infection. Otherwise, patients’ lives are at risk.
If you need TPN infusion therapy from reliable healthcare providers, AmeriPharma® Specialty Pharmacy can help. Our trained nurses know how to prevent CLABSI with TPN and ensure you receive your nutrients safely.
Our ACHC-accredited specialty pharmacy provides convenient treatments, copay assistance, and 24/7/365 support to those with complex medical conditions in 40+ U.S. states.
Contact us now to speak with a patient navigator and start receiving TPN treatments from the comfort of your home.