CURRENT Essentials of Critical Care.pdf

144 Current Essentials of Critical Care■■■Intravenous Catheter-Associated InfectionEssentials of Diagnosis• Local infection at catheter exit site with erythema, purulence,tenderness up to 2 cm from insertion site• Tunnel infection has signs of infection 2 cm from skin insertionsite• Catheter-associated sepsis caused by migration of skin-colonizingorganism to tip of catheter, contamination of catheter hub,or rarely hematogenous seeding of catheter or infusion of contaminatedfluids• Catheter-associated bloodstream infection when same organismgrown from catheter tip and blood cultures• Gram-positive organisms most common (coagulase negativestaphylococci, Staphylococcus aureus), but increasing incidenceof candida, gram-negative organisms (associated with monitoringdevices and contaminated intravenous fluids)• No agreement on quantitative and semiquantitative cultures fordiagnosis; some define infection as 15 colony-forming unitsor 10 3 organism cultured from distal catheter tipDifferential Diagnosis• Chemical phlebitis• Thrombophlebitis or thrombosis of central venous catheter• Bacteremia, sepsis from noncatheter sourceTreatment• Remove catheter whenever possible; removal strongly indicatedin presence of sepsis, or if resistant or difficult to treat pathogenisolated (fungi, Pseudomonas aeruginosa)• Antibiotic therapy against most likely pathogens (empiric vancomycinplus aminoglycoside or cephalosporin is appropriate)■ PearlTo minimize risk of infection, always use a new insertion site for replacementof an intravenous catheter.ReferenceCunha BA: Intravenous line infections. Crit Care Clin 1998;14:339. [PMID:9561821]