CLABSI Flashcards
Q: What is central line-associated bloodstream infection (CLABSI)?
A: CLABSI is a primary bloodstream infection that develops at least 48 hours after central line placement or on the day of removal or the day after, with no other source of infection identified.
Q: What are the most common causes of CLABSI?
A: The most common causes are bacteria such as coagulase-negative staphylococci, Staphylococcus aureus, and enterococci. Less commonly, fungi such as Candida can cause CLABSI.
Q: How do pathogens typically migrate to cause CLABSI?
A: Pathogens can colonize the central line and use its extraluminal surface (from skin microflora) or intraluminal surface (from contamination by healthcare providers’ hands) to reach the bloodstream.
Q: How is CLABSI defined as complicated or uncomplicated?
A: CLABSI is complicated if it involves septic shock, septic thrombophlebitis, or metastatic infection. It is uncomplicated if it does not involve these complications.
Q: What is the first step in assessing a patient suspected of having CLABSI?
A: Perform an ABCDE assessment to determine if the patient is unstable or stable.
Q: What steps should be taken for unstable patients suspected of having CLABSI?
A: Stabilize the airway, breathing, and circulation; obtain IV access; and start IV fluids if hypotensive.
Q: What history and symptoms are typical in patients with CLABSI?
A: A central line in place for more than 2 days, fever, chills, fatigue, and potentially symptoms after central line removal (on the day of or day after).
Q: What physical exam findings might indicate CLABSI?
A: Hypotension, altered mental status, local erythema, tenderness, and purulence at the central line insertion site.
Q: What lab results are typical in CLABSI?
A: Elevated white blood cell count (WBC) and lactate levels.
Q: What should you assess after suspecting CLABSI?
A: Assess for other sources of infection. If another source is found, suspect a secondary bloodstream infection.
Q: How should blood samples be collected for diagnosing CLABSI?
A: Draw two or more blood samples on separate occasions from different sites or at different times to avoid contamination.
Q: What should be done while waiting for blood culture results in suspected CLABSI?
A: Start empiric antibiotics and remove the central line.
Q: How can you diagnose complicated CLABSI from blood culture results?
A: If at least one blood culture is positive for true pathogens or two cultures are positive for commensal organisms.
Q: How long should antibiotic therapy last for complicated CLABSI?
A: 4 to 6 weeks, or 6 to 8 weeks if there is underlying osteomyelitis.
Q: What is the management approach for stable patients suspected of having CLABSI?
A: Obtain a focused history, physical examination, labs (CBC), assess for other infection sources, draw blood cultures, start empiric antibiotics, and consider removing the central line.
