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.
Key red flags
Hypotension, altered mental state, oliguria or raised lactate after line access requires immediate sepsis management.
Fever, rigors or hypotension beginning during flushing or infusion strongly suggests intraluminal contamination but still requires paired cultures.
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.
Key medicines
Empirical severe line-infection regimenGive the locally approved intravenous regimen after paired cultures, covering likely resistant Gram-positive organisms and adding Gram-negative activity according to shock, neutropenia, femoral access and local epidemiology.
Flucloxacillin for MSSAGive 2 g intravenously every four hours for confirmed methicillin-susceptible Staphylococcus aureus bloodstream infection, with duration set by clearance and complication assessment.