Peripherally Inserted Central Catheter Infections

  • Definition

    A peripherally inserted central catheter (PICC) infection occurs when bacteria enters the bloodstream through or around a central line catheter . A PICC is a long, thin tube that is inserted through a vein in the arm. The catheter is threaded through the arm vein until it reaches a larger vein close to the heart. Commonly called a PICC line, it is used to deliver medicine, nutrition, IV fluids, and chemotherapy .
    Veins in the Arm
    IMAGE
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    If bacteria start to grow on the central line catheter , they can easily enter the blood and cause a serious infection. This can lead to a condition called sepsis , which occurs when bacteria overwhelm the body.
  • Causes

    Bacteria normally live on the skin. Since the catheter is inserted through your skin, these bacteria will sometimes track along the outside of the catheter. From the catheter, they can get into your bloodstream.
  • Risk Factors

    Factors that increase your chances of developing this infection include:
    • Having a catheter for a long time
    • Having a catheter that is not coated with a substance that kills bacteria
    • Having a catheter inserted into a vein in the thigh
    • Having a weakened immune system
    • Being in the intensive care unit
    • Having an infection elsewhere in the body or skin
  • Symptoms

    Symptoms may include:
    • Fever
    • Shaking, chills
    • Fast heart rate
    • Redness, swelling, or tenderness at the catheter site
    • Drainage from the catheter site
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done.
    Your bodily fluids may be tested. This can be done with:
    • Blood tests
    • Cultures
    Images may be taken of your heart. This can be done with echocardiogram .
  • Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include the following:
    • Antibiotics—Antibiotics are medicines used to treat an infection. The kind of antibiotic you will be given depends on which bacteria is found in your blood.
    • Central line care—Often, the PICC line will need to be removed and replaced by a new catheter.
  • Prevention

    At the Hospital
    When you are getting a PICC line placed, the staff will take steps to reduce your risk of infection.
    There are also steps that you can take to reduce your risk of infection:
    • Ask the staff to take every precaution to prevent an infection.
    • Tell the staff right away if the bandage needs to be changed or if the site is red or sore.
    • Ask everyone entering your hospital room to wash their hands. Do not allow visitors to touch your catheter.
    At Home
    • Follow all instructions concerning your PICC line.
    • Learn how to take care of your catheter. Follow these general guidelines:
      • Follow specific instructions about showering and bathing
      • Before touching the catheter, wash your hands or use a hand sanitizer. Wear gloves when touching the area.
      • Change bandages as directed
      • Wash the catheter caps with an antiseptic.
      • Do not allow anyone to touch the catheter or the tube.
      • Check the insertion site daily for signs of infection, such as redness or pain.
      • Call your doctor if you think you have an infection.
  • RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov

    Society of Critical Care Medicine http://www.sccm.org

    CANADIAN RESOURCES

    Communicable Disease Control UnitManitoba Health http://www.gov.mb.ca/health/publichealth/cdc/index.html/

    Health Canada http://www.hc-sc.gc.ca

    References

    Central line-associated bloodstream infection (CLABSI). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/HAI/bsi/bsi.html . Updated May 17, 2012. Accessed August 13, 2013.

    Central venous catheter. American Thoracic Society website. Available at: http://patients.thoracic.org/information-series/en/resources/central-venous-catheter.pdf . Accessed August 13, 2013.

    Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S22-30.

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