Central Line Associated Bloodstream Infections (CLABSI)

What is CLABSI?

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:

• Pain
• Redness, swelling, or warmth around the central line site
• Pus or bad smell around the central line site
• Chills
• Fever of 100.4 degrees or above

CLABSI is a serious health risk. 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.

Read More About Fever and Signs of Infection

Central lines in children

Importance of central line care

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. Key steps to central line care include:

1. Limit the use of the central line when possible. Each time the central line is used there is a risk of introducing germs and bacteria.
2. Use correct aseptic technique to access the central line (wash hands, and wear disposable gloves if instructed). Clean access points with alcohol or chlorhexidine as instructed, and allow to air dry. Follow the care team’s instructions to “scrub the hub.”
3. Follow the recommended care schedule for dressing, needle, needleless connector, and tubing changes.

Ways to help prevent central line infection

Keep the central line site clean and dry.

• Care for the central line in an area of the home that can be cleaned with a disinfectant wipe. Wipe surfaces thoroughly before line care.
• Wash hands properly before and after caring for the central line.
• Only family members or caregivers who have been trained by the hospital staff are allowed to care for the line.
• Keep the central line site covered with a clean, dry dressing. If you have been trained, change the dressing or call your doctor right away if it gets wet, dirty, or loose.
• Use a waterproof dressing cover to keep the catheter and dressing dry during baths or showers.
• Use aseptic technique for line access. Wash hands, wear disposable gloves if instructed, clean access points properly, and use sterile devices.
• Avoid touching the line when possible.

Keep the patient and the surroundings clean.

• Make sure your child takes regular baths or showers. Remember to keep the dressing dry. If your child is not able to bathe or shower, use bath wipes as part of the daily cleaning routine.
• Change your child's clothes daily.
• Change bed linens regularly. Avoid re-using towels and washcloths.
• Keep the home environment clean.
• Store foods safely. Keep food items away from medicines and medical supplies.

Take good care of the central line.

• Check lines regularly for breaks, cracks, leaks, tears, or blockages.
• Keep the central line securely in place. Make sure nothing rubs or pulls on the line.
• If your child wears diapers, make sure the line tubing does not get into the diaper. Always secure the central line away from the diaper area.
• Follow the recommended schedule for dressing changes and line care.

Practice good oral care.

• Brush teeth at least twice each day. Use a soft toothbrush and fluoride toothpaste. For babies or patients with mouth sores, use a moist gauze pad or oral sponge.
• Replace the toothbrush regularly, especially if they have a weak immune system or neutropenia. Use a new toothbrush after illness.
• Use a mouth rinse as recommended.
• Apply a lip balm or lanolin moisturizer to keep lips from becoming dry, cracked, or chapped.
• Drink plenty of fluids to stay hydrated and help prevent dry mouth.

Watch for signs of infection.

• Call your doctor at any sign of infection, including fever or chills or if the central line site is red, swollen, or sore.

Risk of central line infection in children with cancer

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:

• Younger age, especially infants
• Weakened immune system and neutropenia
• Having leukemia or recurrent cancer
• Previous bloodstream infection
• Mouth sores, skin sores, or rashes
• Bone marrow (stem cell) transplant
• Poor nutrition status
• Receiving total parenteral nutrition (TPN)

In some cases, factors related to the central line may increase risk of infection. These include:

• Length of time the central line is in place
• Location of the central line in the body (lines in the groin have higher risk than those in the chest or extremities)
• Type of central line (implanted ports have the lowest risk)
• Number of lumens (single lumens generally have lower risk)
• Central line problems such as blockage or need for repair

Causes of central line infection: sources of CLABSI

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 on skin

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.

Mucosal barrier injury

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.

Diagnosis and treatment of central line infection

Treatment of central line infections depends on the source and severity of infection.

• Blood cultures. The care team will perform tests to find out the cause of the infection. This usually involves taking blood samples from the central line and at least one sample from a needle placed in a vein. Samples from other part of the body such as urine might also be collected to test if the source of infection is the central line or other site. Cultures are performed on the samples to find out if bacteria or fungi are present.
• Medicines. Once the source of infection is known, antibiotic or anti-fungal medicines will usually be given.
• Removal of the central line. Central line removal may be needed to treat CLABSI. In some cases, the central line is removed and replaced with a new device, sometimes at a different site. Or, the central line may be removed completely until the infection has cleared. If the central line is kept in place, it is important to give antibiotics though the line to treat line 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.