Intravascular Device Infections

First Things First (assess & treat for the following)

• Definitions
  • Catheter colonization
    • Catheter itself having organisms attached to it but not a current systemic infection
    • A positive catheter culture w/out signs of systemic illness, such as fever, leukocytosis, hypotension or positive peripheral blood cultures
    • Colonization is not synonymous with catheter infection (see below), but multiple studies support a strong association.
  • Catheter-related bloodstream infection (CRBSI)
    • aka line infection, line sepsis or catheter sepsis (if altered hemodynamics)
    • A systemic process originating from the catheter
    • A positive catheter culture & a positive peripheral blood culture (of the same microorganism) or clinical signs of systemic bacteremia/fungemia
    • “Complicated” CRBSIs include septic thrombosis, metastatic seeding (such as endocarditis) & abscess formation.
  • Exit-site infection
    • Erythema, induration & tenderness near the catheter exit site or along the subcutaneous tract of the line
    • Can be confirmed by laboratory culture of any exudate present & may be associated w/ concomitant bloodstream infection
  • Suppurative thrombophlebitis
    • Infection of a thrombus around a vascular device
    • Equivalent to an ‘abscessed’ vein with significant difficulty treating successfully without surgical intervention
• Suspicion of an intravascular device infection should be raised if:
  • There is a device present AND
  • There are exam findings consistent w/ local infection at the line site, OR
  • Pt is experiencing fever, chills, hemodynamic changes or other symptoms of systemic infection without a readily identifiable alternative.
  • Suspicion should also be high if clinical signs of sepsis develop abruptly upon usage of an intravascular device.
• In considering treatment, the basic premises are:
  • If the device is not needed, remove it.
  • If the entrance site is infected, replace the catheter at a new, clean site.
  • If the device is still needed & the entrance site appears clean, but there is suspicion of a catheter infection, consider changing the line over a guidewire or replacing at a new site while obtaining catheter & peripheral blood cultures. Then,
  • If the cultures return as a colonized catheter or a CRBSI, see the Specific Management section below.