CENTRAL VENOUS LINE INFECTIONS

Basic types of CVCs:

1. Un-tunneled- TLC, cordis; short-term access

2. Tunneled- Hickman, Broviac; better if pt requires frequent phlebotomy, blood products, TPN.

3. Subcutaneous- Portacath; lower rate of infection in patients with solid tumors.

4. PICC- intermediate-term access

Mechanisms of infection:

1. skin insertion site

a. exit site infection- <2cm inflammation

b. tunnel infection- >2cm inflammation

c. pocket-space abcess

2. catheter hub

3. hematogenous seeding

4. infusate contamination

Detection:

1. catheter culture- roll plate technique, >15 CFU indicates infection

2. 5-10-fold greater CFUs in BCx drawn from CVC vs. peripherally.

3. >1000 CFUs in CVC BCx.

Treatment:

ABSOLUTE INDICATIONS FOR REMOVAL

1. Bad bugs- S. aureus, Corynebacterium JK, Bacillus, VRE, Lactobacillus casei, P. aeruginosa, polymicrobial infection, Candida, Fusarium.

2. Persistently positive BCxs following 72hrs of appropriate abx.

3. Recurrent bacteremia with the same organism after appropriate treament.

4. Tunnel infection

5. Pocket-space infection

6. Septic-thrombophlebitis

WHEN TO TREAT THROUGH

1. Wimpy bugs- CNS, diphtheroids, alpha-hem Strep

2. Exit-site infection

3. Neutropenia with GI bugs in Cxs that rapidly sterilize on abx (<72hrs)

4. Cellulitis of subcutanous port without fluctuance

Greene. Infectious Disease Clinics of N America. 1996, 10(2): 255-295