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. 2025 Aug;49(6):783-790.
doi: 10.1002/jpen.2788. Epub 2025 Jun 22.

Incidence of catheter-related bloodstream infections with sodium citrate lock therapy in adult patients receiving home parenteral nutrition: A descriptive cohort study

Rachel Leong  1   2 , Nisha J Dave  1   2 , Daniel P Griffith, Anna Guo  3 , Kirk A Easley  3 , John R Galloway  1   4 , Thomas R Ziegler  1   5 , Vivian M Zhao  1   2
Affiliations

Incidence of catheter-related bloodstream infections with sodium citrate lock therapy in adult patients receiving home parenteral nutrition: A descriptive cohort study

Rachel Leong et al. JPEN J Parenter Enteral Nutr. 2025 Aug.

Abstract

Background: We determined the incidence of catheter-related bloodstream infections in adult patients requiring home parenteral nutrition (HPN) while receiving sodium citrate locks.

Methods: We conducted a single-center descriptive cohort study involving 38 adults who required HPN from January 1, 2020, to August 31, 2022. The exact method, assuming a Poisson distribution, was used to estimate the incidence rate of catheter-related bloodstream infections per 1000 catheter days among patients receiving sodium citrate locks. Univariate and multivariate analyses using Poisson regression and frailty models were employed to evaluate predictive factors.

Results: Thirty-eight patients received sodium citrate locks, with 65.8% women (mean age, 50.2 ± 14.5 years). The average length of HPN was 3.6 years. Forty-six catheter-related bloodstream infections occurred during 20,085 catheter days, demonstrating an incidence rate of 2.3 (95% confidence interval, 1.7-3.1) per 1000 catheter days. Peripheral-inserted central catheters had a higher incidence rate (3.9 per 1000 catheter days) than Hickman catheters (2.2 per 1000 catheter days), with a hazard ratio of 1.27, indicating a 27% increased risk of catheter-related bloodstream infections. Univariate and multivariate Poisson regression analyses revealed that for every 1-h increase in HPN infusion duration (h/day), the incidence rate of catheter-related bloodstream infections is expected to increase by 10%.

Conclusion: Catheter-related bloodstream infections are common in adult patients requiring HPN. Sodium citrate locks may help prevent these infections. Recognizing predictive factors, such as the duration of parenteral infusion, can help healthcare providers develop more effective prevention strategies.

Keywords: catheter‐related bloodstream infection; ethanol lock; heparin lock; home parenteral nutrition; sodium citrate lock.

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References

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