Endocarditis complicating home hyperalimentation

J. E. Gatti, N. Reichek and J. L. Mullen

Catheter sepsis remains a persistent, though infrequent, complication of intravenous hyperalimentation (IVH). Those select patients requiring home hyperalimentation delivered through Silastic catheters are subject to this serious problem. Reported in this article is a case of Enterococcus endocarditis of the tricuspid valve in a patient receiving home IVH; the endocarditis was recognized early using two-dimensional echocardiography and was treated successfully with catheter removal and IV antibiotic administration. Ideal conditions exist for the formation of endocarditis in the setting of catheter sepsis with parenteral nutrition. Routine echocardiography is indicated when catheter sepsis is documented, since early diagnosis and treatment may reduce invasive cardiac tissue infection and permanent injury. The right atrial catheter generates reflections during echocardiography that require special attention for accurate interpretation.