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Patients who have a central venous catheter or “central line”, such as a Peripherally Inserted Central Catheter (PICC) line, tunneled catheter, or port, are at risk for central line associated bloodstream infection, or CLABSI. This infection can occur when germs enter a patient’s blood through the central line.
Signs of a central line infection include:
CLABSI is a serious health risk for childhood cancer patients. If a patient has any sign of infection, it is important to contact a doctor right away or go to the emergency room for care. Families should ask their care team for specific instructions on what to do.
A central venous catheter or “central line” is an intravenous catheter placed into a large vein that leads to the heart. During pediatric cancer care, a central line can be used to give medicines, fluids, blood products, and nutrition.
Central lines are important for medical care and quality of life. A central line can often stay in place for the duration of treatment (months to years). However, central lines can sometimes become infected, causing a very serious, life-threatening bloodstream infection. The infection can delay cancer treatment and result in more medical procedures. Surgery may be needed to remove the infected line and place another line. Patients and families should follow instructions for central line care and watch for signs of infection.
Patients, families, and health care providers can all help in CLABSI prevention. Before a patient goes home with a central line, a care team member will teach the steps for line care at home. In the hospital and clinic, patients and families can also help make sure that medical staff follow basic line care steps.
Good line care is the most important way patients and caregivers can reduce the risk of CLABSI. However, it is also important to know factors that may put a patient at greater risk for infection. Children being treated for cancer already have a higher risk for infection, including central line infection. Other factors that increase risk for CLABSI in children with cancer include:
In some cases, factors related to the central line may increase risk of infection. These include:
Central line infections in pediatric cancer patients are usually caused by bacteria. Less commonly, CLABSI may be the result of a yeast or fungal infection.
Germs, including bacteria and fungi, are common on the skin. Central line infections are often caused by skin bacteria from a patient or caregiver. The skin forms a protective barrier to help keep germs from entering the body. However, a central line can provide an entry point for germs either from the central line skin site or from the line hub that leads directly to the bloodstream. When the immune system is weak because of cancer or cancer treatments, the body can’t fight infection as well as normal.
Central line infections can also occur because of bacteria normally found in the mouth or intestines. In cancer patients, chemotherapy and radiation can damage the mucosal barrier along the mouth, throat, and gastrointestinal tract. This is known as mucosal barrier injury (MBI). The mucosal barrier is a protective layer that normally keeps bacteria inside the mouth and digestive system. When this layer breaks down, bacteria can travel to other parts of the body. In some cases, this can cause central line infection. In cancer patients, MBI CLABSI is the more common source of bloodstream infection.
Oral care is important to help control mouth bacteria and lower the risk of infection. Steps of good oral care include:
Treatment of central line infections depends on the source and severity of infection.
Patients will be monitored closely during and after treatment. It is important for patients to continue taking medicines as instructed, even if there is no sign of infection.