Central line–associated bloodstream infections and complications in adult home parenteral nutrition: Observations from a quality improvement initiative
Bibliographic record
Abstract
The literature is inconsistent regarding differences in infection risk between central venous catheter types used for home parenteral nutrition (HPN). Our goal was to determine if significant differences exist in rates of infection and other complications between peripherally inserted central catheters, tunneled central venous catheters, and implanted ports, as well as between single and multiple lumen catheters used for HPN. Data were collected for 141 central venous catheters placed in 89 adults receiving HPN provided by Continuum home health company affiliated with University of Virginia health system. The catheters were 63% peripherally inserted, 27% tunneled, and 10% implanted ports, with 25,273 total catheter days and 15,474 HPN days. Central line-associated bloodstream infection (CLABSI) rates were 0.91 episodes per 1000 total catheter days overall, 1.91 for peripherally inserted, 0.63 for tunneled, and zero for ports. CLABSI rates per 1000 HPN days were 1.49 overall, 2.61 for peripherally inserted, and 0.76 for tunneled catheters. CLABSI rates were significantly greater for peripherally inserted than for tunneled catheters per total (P = 0.023) and per HPN (P = 0.011) catheter days. CLABSI rates were greater, but not significantly so, for multiple than for single lumen catheters. The rate of noninfectious complications was not significantly different between tunneled and peripherally inserted central catheters and was zero for ports. HPN CLABSI rates were significantly lower with implanted ports and tunneled central venous catheters as compared with peripherally inserted central catheters.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.035 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".