CHAPTER 2


This type of infection requires removal of the catheter, catheter replacement at an alternate site, and a course of antimicrobial therapy tailored to the identified organism.19


Systemic catheter infections are usually caused by contamination


of the hub, hematogenous seeding from a distant site, such as an intra- abdominal abscess or urinary tract infection, or contamination from the catheter exit site.5,20


Blood cultures should be drawn for any patient with a CVAD and clinical suspicion for line infection.


Catheter-Related Bloodstream Infection One of the most common and serious complications of PN therapy is CRBSI, which can lead to sepsis, shock, and death as well as increased hospital length of stay and increased costs.1,18,20


PN is historically consid-


ered an additional risk factor for CRBSI; however, improved compound- ing techniques, optimal nutrient composition, improved glucose control, and the implementation of central line bundles (see section “Care of Vas- cular Access Devices”) can lower the risk of PN-associated bloodstream infections.5,21


In addition, knowledge of bloodstream infection pathogen-


esis has advanced, and a greater emphasis has been placed on standard- izing the approach to CRBSI prevention and treatment.10 Patients with CRBSI present with clinical signs of infection, such as


fever, hypotension, shaking/chills, elevated white blood cell count, and altered mental status. Patients receiving HPN therapy must notify their health care team immediately if symptoms of CRBSI are present and may need to present to the emergency department for evaluation. Diagnosis of CRBSI should be made following up-to-date, evidence-based practice. According to the CDC, 3 criteria must exist6


:


ƒ clinical signs of infection, ƒ no alternate source of bloodstream infection present, and


ƒ positive blood culture from a peripheral vein with the catheter tip/ segment culture that matches the organism grown from the blood culture or greater than a 3-fold higher number of organisms grown from the catheter vs the peripheral blood culture on simultane- ously drawn cultures (or growth from the catheter-drawn blood culture that occurs at least 2 hours before growth of the same organism from the percutaneously drawn blood culture).


Empiric therapy should be based on the most likely organism, host


factors, and clinical picture of the patient. In general, coverage for common gram-positive and gram-negative organisms may be necessary.


26


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