Line & Catheter Infection

Infection tracking along a vascular access device or a urinary catheter. Read alongside the Sepsis pathway, which governs the resuscitation — this page is the device-specific part: the cultures, the removal decision and the complication hunt. Worth…

Fever with a device — paired cultures, and does it come out?

The pathway

1 · Find every device

Cannulas, PICCs, tunnelled and non-tunnelled central lines, ports, dialysis catheters
Urinary catheters, including suprapubic
Drains, pacing wires, prosthetic material
Look at the sites. A red, tender or discharging exit site or track is the finding — and a normal-looking line does not exclude infection

2 · The history that points at the line

Rigors on flushing or during dialysis — strongly suggestive of catheter-related bloodstream infection
Fever with no other source after a proper examination
Persistent bacteraemia despite appropriate antibiotics
Recent line insertion or manipulation

3 · Paired cultures — the part that has to be done properly

One set from the line AND one set from a peripheral vein, labelled clearly as such
Taken before antibiotics unless the patient is septic
The comparison — including differential time to positivity — is what identifies the line as the source
Culture the exit site if there is discharge, and send a urine sample if there is a catheter

4 · Treat the patient first

Septic — Sepsis 6 within the hour, cultures alongside rather than first
Empirical antibiotics per local policy, covering Gram-positives including MRSA where plausible
Then narrow with microbiology
Involve microbiology early — this is a conversation, not a prescription

5 · Does the device come out?

Strong presumption toward removal for: Staph aureus, Candida, Pseudomonas, a tunnel or pocket infection, septic shock, or persistent bacteraemia
Remove a peripheral cannula at any suspicion — it costs nothing
Tunnelled lines and dialysis catheters are a harder decision because access is scarce: that is a nephrology, oncology or microbiology conversation today, not a reason to leave it
A catheter-associated UTI may need the catheter changing as part of treatment

6 · Then look for what it seeded

Staph aureus bacteraemia earns a source and complication hunt: echocardiogram for endocarditis, and a low threshold for imaging the spine if there is back pain
Candidaemia — follow the local candidaemia protocol, and assess specifically for ocular symptoms and risk factors for endophthalmitis
Repeat cultures to document clearance
Duration is set by the organism and the complications — days for some, weeks for others

7 · And the one to stop over-diagnosing

A positive dipstick in a catheterised patient is not a UTI. Catheters are colonised within days, essentially always
Treat when there are systemic features, not because the urine looks cloudy or smells
Asymptomatic bacteriuria is not treated outside pregnancy and specific urological procedures
Ask instead: does this catheter still need to be there?

Drugs

Drug	Dose	Route	Notes
Empirical antibiotic	Per local policy	IV	Cover Gram-positives including MRSA where plausible. Local policy and microbiology win.
Antifungal	Per microbiology	IV	Candidaemia means the line comes out and earns an ophthalmology review.
Antibiotic lock	Per microbiology	Line lock	Occasionally used to salvage a tunnelled line when access is scarce. A specialist decision, never a default.

When to escalate

Septic with a device in situ — Sepsis 6 within the hour, and say the device out loud in the referral,Staph aureus or Candida in the blood — presume the line comes out; urgent microbiology discussion and an echocardiogram,Dialysis or tunnelled line in a patient with no alternative access — nephrology or oncology today,Back pain with Staph aureus bacteraemia — think spinal epidural abscess, and image the whole spine

Reference: epic3 / NICE guidance on preventing healthcare-associated infection; national Staph aureus bacteraemia management guidance; local antimicrobial and vascular access policies, which take precedence.

This page is the reference half

The app adds what a web page cannot: a VINDICATE differential builder, worked on-call scenarios with full A–E findings, recall practice, and all of it offline.