I believe I have read somewhere that if a central line is placed and the patient spikes a fever, wbc's increase and has positive blood cultures that during a period of time it can be considered insertion related but beyond that we need to look at the possible care the line has received.
Am I dreaming?   Is it within 48 hours, 4 days, 7 days and we can think insertion?
Thanks for any references you mat share.
I do not recall every seeing anything concretely recommended about this. The presence of biofilm holds the key. There is published information about the amount of biofilm on catheters in relation to their length of dwell. Catheters that have dwelled for less than a week will have more biofilm on their outer surface while catheters that have been in place longer than a week will have more biofilm on the internal lumen. With this information, we can infer that an infectious episode occurring within the first week of dwell is related to the skin while episodes occurring after the first week are probably related to hub manipulation. Armed with this information, we can choose our interventions appropriately. For instance, a patient with a tunneled cuffed catheter in place for 6 months with signs and symptoms of BSI will probably not benefit from the application of a chlorhexidine-impregnated sponge dressing at the insertion site. Hope this makes sense.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861