Central line infection- how long until symptoms occur?

iluvivt, BSN, RN · Nov 6, 2015

That is going to depend upon when and how and the organism was introduced into the system. In general when you have a CRBSI from insertion to approximately ten days post insertion it is usually insertion related.This could mean that maximal barrier precautions were not followed. If the CRBSI manifests after 7 to 10 days after insertion it is usually related to the use and care of the device.The majority of infections during this time frame are introduced from needleless connectors. I will share more but this is from my phone and it's difficult to do a long post.

Seas · Nov 6, 2015

This is several weeks after the insertion. So, it is definitely not insertion but maintenance related. From needleless ports during flushes, spiking new IV bags, or cap changes, microorganisms entered the line. Or from the skin at the insertion site, somehow. What I actually wonder is that how long after being exposed to infection-causing microorganism until the symptoms such as fever occur... Is this a matter of a few hours, or days, or what...

What I am trying to figure out is that, a patient I cared for got fever and got the central line removed out by MD the day after I cared for him. The last time I did anything with his central line was about 33 hours before he developed fever. So I cant help but think if I unintentionally did something to contribute to this infection or was it someone after me... Or did it just happen regardless everyone followed the infection control measures.

MunoRN, RN · Nov 6, 2015

I think you may be jumping the gun by assuming the patient definitely had a CLASBI just because they developed a fever. There are a long list of reasons why a patient can develop a fever, bacteremia is just one of them.

iluvivt, BSN, RN · Nov 7, 2015

Was there an actual blood culture done that was positive or did the provider take it out because the wbc ct was going up and the pt had a fever? It is considered a BSI associated with a central line if the line was in use during the 48 hr period before the development of the BSI. So there is your answer..so yes it could have been at the time of a cap change if the hub was not scrubbed well...it could have been introduced if needleless connectors was not scrubbed well or even if it got wet at the insertion site and none changed it. Odds are that the pathogen was introduced intraluminally through the hub or needle less connector.There is also a chance that it was introduced through the percutaneous skin tract.Do you know anymore about the care or hx of the catheter...was a wet dsg left on...we're the caps consistently changed at least every 7 days...what type of CVAD is it and how many lumens?

iluvivt, BSN, RN · Nov 7, 2015

I am happy to help if you would like to lean more....I can point out some good resources. ...I love this stuff...might be boring to some but not to me!

Seas · Nov 7, 2015

I am open to any resources. :)

I am careful and particular with my lines actually. Infection risk is always in my mind, and I make sure to alcohol swab and use alcohol caps for my lines.

This was a double lumen subclavian central line (broviac). Blood culture did come back positive for something that I dont remember what microorganism it was.

The only thing I didnt do that I was supposed to do was to rub around the line before putting a new cap. Like in the picture below, I was supposed to alcohol swab the brown part even before removing the old cap, per policy. I got distracted by patient and only switched the caps, forgetting that step. This was only for one lumen, after that, I remembered and wiped the other port. For both lumens, I maintained sterility, I had sterile gloves, mask, I didnt let anything touch the open port during the cap change. I just switched the cap in a quick manner but without wiping around the open port. This is the only thing in my mind that I am worrying. Did I contribute to this infection by skipping that stage... I hope not.

Seas · Nov 7, 2015

Sorry, that picture looks too large, and I couldnt resize it. I found it online, and it looks smaller online.

But anyway, I dont think my question was understood correctly. I mainly wonder how long it takes to become symptomatic once a bacteria is introduced. For example, if a person contaminates a central line, how soon would the patient start showing signs like fever?

nursej22, MSN, RN · Nov 7, 2015

It would depend on the bacterial load, the type and virulence of the organism, and the patient's own immune system.