# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393505&lang=en  
> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

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.

| Time | Data |
| --- | --- |
| Day 7 (baseline) | T 36.9 C, HR 78, BP 124/72, WBC 4.5, line site dry intact |
| Day 8 morning | T 38.4 C, HR 96, BP 116/68, WBC 8.2, line site mild erythema 1 cm |
| Day 8 evening | T 39.1 C, mild rigors, HR 110, BP 102/62, WBC 14.2, line site erythema 3 cm and tender |
| Day 9 morning | Blood cultures from central line growing gram-positive cocci at 14 hours; peripheral cultures still pending |

Q1. What does the trend suggest?

Expected post-chemotherapy fever pattern
Stable recovery from neutropenia
Progressive central line-associated bloodstream infection (CLABSI)
Allergic reaction to chemotherapy

Q2. Which is the priority nursing action at day 8 evening?

Continue current line for chemotherapy and monitor closely
Notify provider STAT, draw paired blood cultures (peripheral and from each line lumen), start empiric broad-spectrum antibiotics within 60 minutes if ordered, and prepare for line removal if CLABSI is confirmed
Switch the chemotherapy infusion to a different lumen of the central line and continue
Remove the central line immediately without drawing cultures

## 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.

## In-depth explanation

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.

## Clinical scenario

**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).

## Key concepts

- **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.

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