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November 2, 1979, Vol 242, No. 18 >
ARTICLE | November 2, 1979

Pyogenic Arthritis Caused by a Total Parenteral Nutrition Line

Ken Kudsk, MD; P. Jeff Fabri, MD; Robert L. Ruberg, MD
JAMA. 1979;242(18):1995. doi:10.1001/jama.1979.03300180039029.
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THE INCIDENCE of catheter-related sepsis during total parenteral nutrition (TPN) can be reduced1 to 1% to 2% when several principles are observed: (1) aseptic catheter placement by qualified personnel; (2) meticulous line care, with use of antiseptic ointment and an occlusive dressing; and (3) maintenance of an absolutely closed infusion system.2 Constant surveillance is essential to ensure early diagnosis of TPN-related sepsis, but verification that the central line is the cause of fever is not easy. The majority of patients have ongoing infections, and cultures of most suspected catheters are in fact negative.3

Aware of these facts, several authors have suggested that catheter removal be delayed 12 to 24 hours after the onset of fever if no obvious cause is found, and even longer if an infectious process can be confirmed and treated. Even when guidelines for line management are carefully observed, physicians must suspect central lines

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