Intra-vascular catheter-related infections may occur when peripheral IVs, central venous lines, arterial lines, and PA catheters are used. It is estimated that about 5% of patients with central venous cannulae and 1% with arterial cannulae develop serious infections related to the cannulae. Bacteria may gain entry to the circulation through the site of cannula insertion, be introduced through the hub of the catheter, or be directly infused (in the case of contaminated solutions). Diagnosis should be made by drawing peripheral blood cultures and cultures through the line (if possible). The line should also be inspected for any signs of inflammation. Generally, if a catheter-related infection is suspected, the line should be taken out immediately and the catheter tip sent for culture. Diagnosis of a catheter-related infection is supported if the same organism is isolated from both the catheter tip and from the blood.
Coagulase-negative staphylococci, S. aureus, and Candida are the most commonly encountered pathogens. Decisions regarding type and duration of antibiotic therapy depend on the patient's clinical condition, the organism grown, and the type of catheter. Whether or not a permanent line need be removed in the presence of a suspected infection can be a difficult decision. In the case of a suspected catheter-related infection, it is best to seek the diagnosis and request microbiology consultation for guidance of empirical therapy.
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