Patients are being discharged on home nutrition by TPN by way of PICC lines and Ports. The most common serious complication is line sepsis or blood clots.
“In the non-specifically unwell patient a clinician should not be misled by a normal white cell count and apyrexia (no elevation of temperature),” states Anna Clare, author of “What Information Should Lead to a Suspicion of Catheter Sepsis in Home Parenteral Nutrition (HPN) published in the Clinical Nutrition Journal.
Greg Vigna, MD, JD, national product liability attorney and PICC line and midline attorney, states, “Patients are being discharged on home nutrition by vein, also referred to as TPN, by way of PICC lines and Ports. The most common serious complication is line sepsis or blood clots. We are reviewing all cases of PICC lines and midline bloodstream infections and blood clots caused by catheter that are not designed to reduce the risk of blood clots, because these blood clots lead to sepsis.”
In her article, Anna Clare wrote that the most common way of diagnosing a catheter-related bloodstream infection (CRBSI) from a PICC or other central line is to order two blood cultures, one from the line and one from a peripheral venous site. Unfortunately, one-third of the patients in the study who required IV TPN that were diagnosed with a catheter-related bloodstream infection by way of blood cultures didn’t have a fever and two-thirds had a normal white-blood-count. In fact, the author’s conclusions included that “In the non-specifically unwell patient a clinician should not be misled by a normal white cell count and apyrexia (no elevation of temperature)”. Simply a patient on TPN who had a “feeling of unwell” was found to be associated with positive blood cultures.
“(Patients) should not be exposed to unnecessary risk simply because a hospital has on the shelf a design without anti-thrombotic properties since they lead to predictable blood clots…” — Greg Vigna, M.D., J.D.
The bacteria isolated from those in the study from catheter-related bloodstream infections included Staphylococcus aureus, MRSA, and Gram-negative organisms. One of the patients had a polymicrobial infection with Candida albicans, a fungus.
Dr. Vigna adds, “PICC lines have been available since 2013 with coating that reduces the risk of thrombotic complications that are blood clots. Any design of a central venous catheter such as a PICC line that reduces the risk of blood clots should be available to physicians across the country because blood clots as serious complications and blood clots get infected leading to sepsis.”
Dr. Vigna concludes, “Patients who require home nutrition by vein are ill and include those with chronic intestinal failure. They should not be exposed to unnecessary risk simply because a hospital has on the shelf a design without anti-thrombotic properties since they lead to predictable blood clots in approximately 1/3 of patients and then increase the risk of infection.”
Dr. Vigna is a California and Washington DC lawyer who represents those impacted by serious injuries cause by defective medical devices. He represents the injured with the Ben Martin Law Group, a national pharmaceutical injury law firm in Dallas, Texas. The attorneys are product liability and medical malpractice attorneys, and they represent the most injured across the country.
Greg Vigna, MD, JD
Vigna Law Group
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