Effect of Delaying Replacement of Parenteral Nutrition Intravenous Administration Sets: Preclinical Experiments and a Dynamic Laboratory Model of Microbial Colonization

Abstract

Background: Recommendations prescribe daily intravenous administration set (IVAS) replacement for parenteral nutrition (PN) comprising intravenous fat emulsions (IVFE) due to risk of micro‐organism growth and resultant central‐line associated bloodstream infections (CLABSIs), but system disconnection for this practice may allow contamination and CLABSIs.

Materials and Methods: Laboratory experiments and model development were used to simulate PN administration after contamination from healthcare workers’ hands. This study observed the growth of micro‐organisms known to cause CLABSIs in a variety of PN and other IV fluids and developed a model to investigate the effect of delaying IVAS replacement on microbial growth for up to 7 days.

Results: Micro‐organisms grew at different rates and were affected by solution type. In static experiments, growth was supported in IVFE and all‐in‐one PN, but suppressed in 50% glucose. Growth patterns were consistent over time for Staphylococcus epidermidis, Staphylococcus aureus, and Candida albicans in IVFE, all‐in‐one PN, and 0.9% sodium chloride in both static and dynamic experiments. C. albicans grew exponentially to clinically significant numbers in all‐in‐one PN and IVFE IVAS after 30 hours, but negligible growth of S. epidermidis or S. aureus occurred for 7 days.

Conclusion: All‐in‐one PN and IVFE support the C. albicans growth after minimal initial contamination, with micro‐organisms migrating from the fluid bag to the central venous access device. Improved aseptic nontouch technique during clinical practice is vital to prevent contamination. Daily IVAS replacement of for all‐in‐one PN and IVFE should continue until the safety of prolonging IVAS replacement is confirmed by randomized trials.