Synopsis
Recognise catheter-related bloodstream infection, obtain paired cultures correctly, distinguish local from systemic disease and decide promptly between line removal and carefully selected salvage.
- Check line type, insertion date, lumens, indication, recent manipulation, parenteral nutrition, dialysis use and whether alternative access is possible.
- Inspect the exit site, subcutaneous tunnel and implanted-port pocket for erythema, tenderness, discharge, erosion and fluctuance.
- In a stable adult collect equal-volume paired blood cultures from a peripheral vein and each relevant catheter lumen before antibiotics.
- A catheter culture becoming positive more than two hours before the paired peripheral sample supports a catheter source when sampling and incubation are comparable.
- Do not culture a catheter tip unless the line is removed; send the distal segment using the laboratory method.
- Remove the catheter promptly for severe sepsis, tunnel or pocket infection, S aureus, Candida, persistent bacteraemia or complicated infection.
- Selected uncomplicated coagulase-negative staphylococcal infection in essential long-term access may be salvaged only with systemic therapy plus a protocolised antimicrobial lock.
- Daily necessity review and aseptic insertion and access practices prevent more infections than routine prophylactic antibiotics.
Key red flags
Hypotension, altered mental state, oliguria or raised lactate after line access requires immediate sepsis management.
Purulence, tunnel tenderness, port-pocket inflammation or skin necrosis usually requires catheter removal rather than salvage.
Staphylococcus aureus, Candida or persistent bloodstream growth carries high risk of endocarditis and metastatic infection.
Positive cultures continuing beyond 48 to 72 hours of active therapy suggest retained infected catheter, thrombus or deep focus.
New murmur, conduction change, embolic event, back pain or hot joint demands targeted assessment for dissemination.
Painful arm or neck swelling with bacteraemia may indicate septic catheter-associated thrombosis.
Fever, rigors or hypotension beginning during flushing or infusion strongly suggests intraluminal contamination but still requires paired cultures.
Tenderness, induration, erythema or fluctuance along a tunnel or over an implanted reservoir indicates deep device involvement.
Bloodstream infection without urinary, respiratory, abdominal or other source should prompt review of every vascular device and access episode.
Persistent fever with ipsilateral neck, chest or arm swelling suggests infected venous thrombus around the catheter.
Investigation priorities
Compare organism growth from equal-volume samples collected at nearly the same time before antibiotics.
Management branches
Line infection is suspected and the adult is stable enough for cultures before antimicrobials.
- Pause non-essential infusions, disinfect hubs correctly and take equal-volume peripheral and catheter blood-culture sets at nearly the same time.
- Label peripheral site, every sampled lumen, exact collection time and recent antimicrobial exposure before transport.
- Inspect and document exit, tunnel and pocket findings; seek alternative sources through history and examination.
- Retain the line temporarily only when no mandatory removal criterion exists and there is a documented review time.