The impact of a nutritional support team on the cost and management of multilumen central venous catheters

Total parenteral nutrition (TPN) is most commonly delivered into a large vein through a central venous catheter (CVC). Because complications associated with CVCs may be life threatening or costly to the patient and the medical facility, proper care and maintenance of a CVC is essential. A 12-month retrospective study was conducted by a nutritional support team to evaluate cost effectiveness of CVC care in patients receiving TPN. Certain factors, such as catheter type and location, duration of usage, number of catheters, physician who placed the catheter, and complications were recorded for each patient receiving TPN. All CVCs used for TPN were maintained by a member of the nutritional support team. A total of 434 CVCs were placed in 277 patients who required TPN (average, 1.6 catheters/patient; range, 1-10 catheters/patient). Specific catheter-related data, and occurrences of complications were recorded on a flow sheet designed specifically for patients requiring TPN. Major complications (those which potentially increased mortality and morbidity) and minor complications (those that did not prolong hospitalization) were distinguished and the average cost of these complications was determined based on actual patient charges. Major complications occurred in 5% of the catheters placed, including: pneumothorax, thoracic duct fluid leak, artery laceration, malposition, failed attempts, and catheter-related sepsis. Catheter-related sepsis occurred in only 0.5% of patients, compared with a reported incidence of 5%, and cost an average $20,200. Thus, complications of CVC may be reduced when maintenance is provided by a skilled clinician or specific team, decreasing the cost, as well as improving the quality of care.