Intravascular Catheter-Related Infections
last authored: March 2010, David LaPierre
last reviewed:
Introduction
Many of the nosocomial bloodstream infections are due to intravascular catheters (catheter-related bloodstream infection, or CRBSI).
Peripheral catheters include IVs, arterial catheters, and midline catheters.
Central catheters can be tunneled or non-tunneled. These include:
- peripherally inserted central catheters (PICC)
- tunneled venous cathers (Broviac, Hickman)
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Coagulase-negative Staphylococci are the most common pathogen. Others include. S aureus, enterococcus, Candida, and gram-negative rods such as Pseudomonas.
Pathophysiology
Bacteria enter the bloodstream most commonly following invasion at the catheter entry site. They may also enter through seeding or contaminated infusion material.
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Two sets of blood cultures should be drawn, one through a peripheral vein and the other through the catheter.
Diagnostic Imaging
Differential Diagnosis
Treatments
Management of complications is critical.
The catheter should be removed if peripheral.
Central lines which cannot be removed can be treated with an antiobiotic lock. Candida has less success.
Consequences and Course
Resources and References
Topic Development
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