P.65 "IN VIVO" EXP~IMENTAL SIUDY OF A NEW HUB DESIGNED 'ID PREVENT CATHETER CONTAMINATION AND SEPSIS. M. Sequra BadIa, A. Sitqes-Serra, C. Alia, L. Qns, J. Valverde, J.M. Torres. Depa&ents of Surgery and Microbiology, Hospital de1 Mar, Autoncmous University of Barcelona, Barcelona, Spain.

Catheter hub is probably the most ccnmon route of infection in prolonged central venous catheterization. We have designed a new hub model (NBM) aiming to prevent the access of microorganisms to the catheter lumen and have tested its antibacterial properties in an experimental model of catheter sepsis in the rabbit. The NHM incorporates an antiseptic chamber containing 3% iodinated alcohol through which the male needle must pass before connecting both ends of the line. Four groups of rabbits equipped with central venous catheteres were studied. In two control groups (CG) standard Luer-lock connectors were used and in two study groups (SG) catheters were provided with the NHM. In a first experiment, the hubs of a CGI (n=9) and a SGl (n=6) were contaminated with 7 bacterial suspension of Pseudcmonas aeruqinosa with an inoculum higher than 10 c.f.u. In a second experiment the same procedure was ftillowed with an incculum of Staphylococcus epidennidis of the same magnitude (cG2, n=8, SG2, n=5). We evaluated dailv the course of the animals usins four clinical variables and the catheter was withdrawn either at the end of the study period or when the animals showed signs of sepsis. Blood cultures were taken and catheter tip was cultured by the Maki extraluminal method (EXL) and a modified Cleri endoluminal method (ENL). In CGI we observed severe clinical sepsis in 8/9 animals, 5/9 positive blood cultures, 919 positive ENL and 619 EXL cultures. In CG2 we did not observe signs of sepsis, O/9 positive blood cultures, 219 positive ENL and 219 positive EXL. In SGl and SG2, in which catheteres were protected with the NHM, there were no bacteremias nor positive catheter tips. We conclude that the WHM was very effective in preventiq catheter contamination and sepsis and that contaminated Luer-lock connectors resulted in different clinical and bacteriological pictures depending on the infecting microorganism. This investigation was supported by grants of the I.M.I.M., C.I.R.I.T. and F.I.S.S.S.

P.66 SPECIFICITY OF HYPERGLYCAEMIA DURING INTRAVENOUS NUTRITION IN PATIENTS WITH PANCREATITIS. M Madan, D Alexander, MJ McMahon. The General Infirmameds, UK

University Department of Surgery,

Severe acute pancreatitis CAP) is a highly catabolic 'septic' condition which causes similar metabolic abnormalities to other forms of sepsis. These abnormalities include hyperglycaemia, especially in patients who receive intravenous nutrition (IVN). The aim of this study was to assess the incidence and severity of hyperglycaemia caused by IVN in patients with AP compared to other septic patients.

The study included 78 patients who received IVN during a period of 6 months. Fourteen patients has severe AP - median simplified acute physiology (SAP) score 7.5, 29 had other forms of sepsis - median SAP score 7, and 35 were not septic. In all patients, IVN was commenced using a standard regimen which provided 13 g N and 1550 kcal daily. Hyperglycaemia was defined as blood glucose >ll mmolll for 24 h. The incidence of hyperglycaemia was 93% in AP, 59% in other septic patients, and 11% in non septic patients. In 5 patients with AP (38%) it was possible to control hyperglycaemia by reducing glucose from 3879 to 1949 but in 8 (57%) insulin was required. The median daily insulin requirement to control hyperglycaemia was 68 units in patients with AP, and 41 units in septic patients (p<O.O3). Patients with AP who needed insulin were older (p<O.O3 and more septic (pt0.02). Hyperglycaemia was more common and more severe in patients with AP than in other patients with a similar severity of sepsis and was most commonly found in elderly patients with severe pancreatitis.

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