Catheter-Associated Bloodstream Infection

What is catheter-associated bloodstream infection?

Catheter-associated bloodstream infection (CABSI) is an infection in the blood that can happen when you have a catheter in a blood vessel. A catheter is a small tube inserted through the skin and into a blood vessel. It may be used to give you fluids and medicines. It may also be used to draw blood.

Most often a catheter is placed into a vein in the wrist or arm. Sometimes it is put in the hand. A type of catheter called a central line is usually placed in the chest, neck, arm, or groin. A central line is preferred if you need to have a catheter for several days or weeks. For example, a central line may be used if you need to have several days or weeks of chemotherapy.

How does it occur?

Your blood can get infected by the catheter if bacteria or other germs travel down the catheter and into the blood. The infection usually happens because the place where the catheter enters the vein is contaminated with bacteria. This may happen, for example, if:

• Your healthcare provider did not clean his or her hands properly before inserting the catheter.
• Your skin was not cleaned properly before insertion of the catheter.
• Your providers do not use proper technique to give medicines or draw blood through the catheter.
• The area around the insertion site is not kept clean.
• The bandaging around the insertion site is not regularly checked and changed when it gets dirty.
• Your providers are not regularly checking for signs of irritation and infection.
• You are not given a fresh catheter at a different site after the recommended number of days. (Usually short-term IVs should be changed every 3 to 4 days.)

Sometimes the cause of the infection is not known.

What are the symptoms?

If you get a catheter-associated bloodstream infection, you may have a fever and chills. The skin around the catheter may be sore and red. The first symptom in older adults may be confusion.

How is it diagnosed?

If your healthcare provider thinks you may have a catheter infection, you will have a blood test to look for signs of infection and bacteria in the blood. Usually the infected catheter will need to be removed. The catheter may also be tested for bacteria.

How is it treated?

CABSI is a serious infection. It will be treated with antibiotics. Blood tests and bacteria from the catheter help your healthcare provider know which antibiotics will be most effective.

Some bacteria have become resistant to many antibiotics. This means that the antibiotics no longer kill the bacteria. These infections are very hard to treat. The infection can become life threatening. This is why all staff, patients, and visitors must follow all of the rules for clean, antiseptic care.

If you have an infection, the catheter might need to be removed as part of the treatment. If you still need a catheter, you will get another catheter placed at a different site.

How long will the effects last?

CABSI can usually be treated successfully with antibiotics, but the infection can be life threatening. If you are in an intensive care unit (ICU), the risk of a fatal infection is higher for a number of reasons. For example, you are more likely to be exposed to antibiotic-resistant bacteria in the ICU, and you may have more than 1 central line. If the catheter was inserted as an emergency measure, sterile technique may not have been the highest priority at the time.

Even when it is successfully treated CABSI can cause significant illness. You will likely need to stay in the hospital for a longer time. It will probably also take you longer to recover after you go home.

How can CABSI be prevented?

IV catheters are life-saving in many cases, but they must be treated with care and respect. While you are in the hospital the health professionals who insert, monitor, and care for these catheters must follow the best known techniques for preventing contamination and infection. They should:

• Carefully choose the best spot for the catheter.
• Clean your skin with an antiseptic cleanser before putting in the catheter.
• Cover you with a sterile sheet and wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter.
• Clean their hands, wear gloves, and clean the catheter opening with an antiseptic solution before using the catheter to draw blood or give medicine.
• Carefully handle medicines and fluids that are given through the catheter.
• Clean their hands and wear gloves when they change bandages.
• Decide every day if you still need to have the catheter. The catheter should be removed as soon as it is no longer needed.

Some things you can do to protect yourself from infection while you are at the hospital are:

• Ask your doctors and nurses to explain why you need the catheter and how long you will have it.
• Make sure that all doctors and nurses caring for you clean their hands with soap and water or an alcohol-based hand rub before and after caring for you. If you do not see them clean their hands, ask them to do so. Also remind everyone who enters your hospital room--whether family, friends, or staff--to clean their hands. Visitors should not touch the catheter or the tubing.
• If the bandage over the catheter insertion site comes off or gets wet or dirty, tell your nurse or doctor right away.
• Tell your nurse or doctor if the area around your catheter is sore or red.

If you still have a catheter when you go home from the hospital:

• Your providers will teach you how to care for it at home. Make sure you understand how to care for the catheter before you leave the hospital. For example, ask for instructions on showering or bathing with the catheter and how to change the catheter dressing.
• Make sure you clean your hands with soap and water or an alcohol-based hand rub before handling your catheter.
• You should have a phone number you can call for help 24 hours a day in case you have a problem.
• Watch for the signs and symptoms of catheter-associated bloodstream infection. Call your provider right away if:
  • You have a fever of 100.5°F (38°C) or higher.
  • You have shaking chills.
  • You have tenderness or pain at the place where the catheter is inserted.
  • You have redness at the insertion site.
  • You have red streaks going out from the insertion site.
  • You have pus or drainage from the insertion site.
• Call during office hours if:
  • You want to make your follow-up appointment.
  • You have any questions about your care.

If you are not yet in the hospital but planning to have surgery or a stay at the hospital, don’t be afraid to ask if you will have a catheter. You may want to ask about the risk for infection and what your providers will do to prevent infection. If your healthcare provider is not comfortable with your questions, then you may need to decide if you would be more comfortable with a different practitioner.