An adult with a triple-lumen central line for chemotherapy develops fever on day 8 of line dwell. Review the trend and answer the questions.
Trend
Choose your responses, then check the answer.
Explanation
The trend shows progressive infection: fever rising, WBC trending up, line site becoming erythematous and tender, blood cultures growing organisms. Priority actions: draw paired blood cultures (one peripheral, one from each lumen of the central line) BEFORE antibiotics if patient stable, start empiric broad-spectrum antibiotics within 60 minutes (especially if febrile neutropenia), notify provider, prepare for line removal if cultures match line organism with no other source. Continuing the line without workup risks septicemia.
Paired blood cultures (peripheral + central line) are the diagnostic gold standard for CLABSI; positive central line cultures growing 2+ hours BEFORE peripheral cultures suggests CLABSI. The line is removed when CLABSI is confirmed; antibiotics alone may not clear biofilm. Continuing chemotherapy through an infected line is contraindicated.
Adult with triple-lumen central line for chemotherapy on day 8 of line dwell. New fever, mild rigors, and erythema at insertion site. The team suspects central line-associated bloodstream infection (CLABSI).
CLABSI diagnosis — Paired blood cultures (peripheral + each line lumen); time-to-positivity > 2h faster from line suggests CLABSI.
Differential time to positivity — Central line cultures growing 2+ hours before peripheral cultures supports CLABSI diagnosis.
Line removal indication — Line removed for CLABSI with S. aureus, Pseudomonas, fungi, persistent positive cultures, sepsis, or embolic complications.