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# Catheter-related bloodstream infection: prevention and response

- Concept

Germs can travel along a central line into the blood; careful insertion, clean handling and early removal prevent most of these serious infections.

Updated Nov 13, 2026

## Key points

- CLABSI is a surveillance definition (central line in place for more than two days, no other source); CRBSI is a clinical diagnosis that proves the catheter is the source.
- Insertion bundle: hand hygiene, maximal sterile barriers, chlorhexidine-alcohol skin antisepsis, the best site (avoid femoral in adults) and ultrasound.
- Maintenance: scrub the hub before every access, keep the dressing clean and intact, and remove the line as soon as it is not essential.
- Take paired blood cultures (through the line and from a peripheral vein) before antibiotics; earlier positivity of the line sample points to the catheter.
- Remove the catheter in septic shock, tunnel or pocket infection, persistent bacteraemia, and in infection with Staphylococcus aureus, Pseudomonas or Candida.

## What it is

A central line-associated bloodstream infection (CLABSI) is a bloodstream infection in a patient who has had a central line for more than two days, with no other source found; it is a surveillance definition used to measure quality. A catheter-related bloodstream infection (CRBSI) is the stricter clinical diagnosis: the same organism grows from the blood and from the catheter, shown by a tip culture or by the catheter sample turning positive clearly earlier than a peripheral sample. Organisms reach the bloodstream mainly along the outside of the catheter from the skin (early after insertion) or through the lumen after contamination of the hub (with longer use), and then live in a biofilm that protects them from antibiotics. The usual causes are coagulase-negative staphylococci, Staphylococcus aureus, enterococci, gram-negative bacilli and Candida. These infections prolong stay, raise costs and kill, yet most are preventable: insertion and maintenance bundles, applied every time and checked by the whole team, have cut their rates sharply.

## Key points

- Early infections come mostly from skin organisms tracking along the outside of the catheter; later ones come from contaminated hubs and the lumen.
- Biofilm on the catheter shields organisms from antibiotics and host defences, which is why removal often matters more than the drug.
- Risk rises with the number of lumens, days in place, femoral site, parenteral nutrition, frequent access and breaks in aseptic technique.
- Candida is more likely with parenteral nutrition, broad-spectrum antibiotics, a femoral line, haematological malignancy or transplant.
- Fever is often the only sign; inflammation or pus at the exit site is specific but uncommon.

## How it works

- Paired cultures compare where organisms are densest: a line sample that turns positive clearly earlier than the peripheral one suggests the catheter is the source.
- Chlorhexidine binds to the skin and keeps killing organisms for hours, so it outperforms antiseptics that act only while wet.
- Changing a line over a guidewire keeps the same infected tract, so an infected line is replaced at a new site.

## Step by step

- Insert with the full bundle and a checklist, and let the nurse stop the procedure if a step is missed — this prevents most early infections.
- Scrub every hub before access and keep the dressing dry and sealed — this blocks the intraluminal route.
- Review the need for every line on the daily round — removal is the strongest prevention.
- When infection is suspected, take paired blood cultures before antibiotics — this confirms the source and guides therapy.
- Start empirical antibiotics covering resistant gram-positives, adding gram-negative or antifungal cover by risk — delay worsens outcomes.
- Remove the line when indicated and place any new one at a different site — the biofilm stays on the old catheter.
- Narrow antibiotics to the culture results and set the course by organism and complications — this limits resistance and harm.

## In practice

- Do not send catheter tips for culture routinely after removal; culture them only when infection is suspected.
- Do not change central lines on a fixed schedule to prevent infection; it adds insertion risk without benefit.
- Staphylococcus aureus bacteraemia needs line removal, repeat blood cultures, echocardiography to look for endocarditis, and a long course of therapy.
- Coagulase-negative staphylococci in a single culture may be contamination; two positive sets or a positive paired set make infection more likely.
- Lines that cannot be replaced easily (long-term tunnelled lines) may be kept in selected uncomplicated cases with lock therapy, decided with infectious diseases.

## Next step

- Call a senior when a patient with a central line develops septic shock: the line is a likely source and may need urgent removal.
- Repeat blood cultures after starting treatment to document clearance, especially for Staphylococcus aureus or Candida.
- Ask for echocardiography in Staphylococcus aureus bacteraemia and in persistent bacteraemia; involve infectious diseases.
- Report every CLABSI to the infection prevention team and review the case for missed bundle steps.
- Keep auditing bundle compliance and infection rates per thousand line-days and share them with the unit.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the difference between CLABSI and CRBSI?

CLABSI is a surveillance definition: bloodstream infection with a central line in place over two days and no other source. CRBSI is a clinical diagnosis proving the catheter is the source.

## What are the main elements of a central line insertion bundle?

Hand hygiene, maximal sterile barrier precautions, chlorhexidine-alcohol skin antisepsis, choosing the best site (avoiding femoral in adults), and ultrasound guidance.

## Why is a catheter removed rather than treated in place in Staphylococcus aureus or Candida infection?

These organisms form biofilm and spread to distant sites; leaving the line causes persistent infection, relapse and complications such as endocarditis.

## How do paired blood cultures help diagnose catheter-related infection?

If the sample through the catheter turns positive clearly earlier than the peripheral sample with the same organism, the catheter is the likely source.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anaesthesia/catheter-related-bloodstream-infection-prevention-and-response/)

## Elsewhere in DurgiPedia

- [Central venous catheter care](https://durgical.com/en/nursing/central-venous-catheter-care/)
- [Hand hygiene: the five moments and the technique](https://durgical.com/en/nursing/hand-hygiene-the-five-moments-and-the-technique/)
- [Clean and sterile technique: medical and surgical asepsis](https://durgical.com/en/nursing/clean-and-sterile-technique-medical-and-surgical-asepsis/)
- [Fever, infection and sepsis: the bedside signs](https://durgical.com/en/clinical-exam/fever-infection-and-sepsis-the-bedside-signs/)

## Connections

## Related 5

- [Central lines in the ICU: choice, checks and removal](https://durgical.com/en/anaesthesia/central-lines-in-the-icu-choice-checks-and-removal/)
- [The ICU daily bundle (FAST HUGS and similar checklists)](https://durgical.com/en/anaesthesia/the-icu-daily-bundle/)
- [Fever in the ICU: an approach](https://durgical.com/en/anaesthesia/fever-in-the-icu-an-approach/)
- [Shock: a bedside approach by type](https://durgical.com/en/anaesthesia/shock-a-bedside-approach-by-type/)
- [Nutrition in the ICU: enteral first](https://durgical.com/en/anaesthesia/nutrition-in-the-icu-enteral-first/)

## Related conditions 3

- [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/)
- [Infective endocarditis](https://durgical.com/en/conditions/infective-endocarditis/)
- [Candidiasis: oral, oesophageal and invasive](https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/)

## In Pharmacology 4

- [Vancomycin](https://durgical.com/en/pharmacology/vancomycin/)
- [Echinocandins](https://durgical.com/en/pharmacology/classes/echinocandins/)
- [Chlorhexidine](https://durgical.com/en/pharmacology/chlorhexidine/)
- [Antiseptics, disinfectants and sterilants](https://durgical.com/en/pharmacology/classes/antiseptics-disinfectants-and-sterilants/)

[← All of anaesthesia](https://durgical.com/en/anaesthesia/)

Educational content; it does not replace supervised training, your institution's protocols or the anaesthetist's or intensivist's decision. It contains no doses and no ventilator or infusion settings.

Sources: [Central Line–Associated Blood Stream Infections](https://www.ncbi.nlm.nih.gov/books/NBK430891/) (StatPearls (NCBI Bookshelf), 2022); [Central Line Management](https://www.ncbi.nlm.nih.gov/books/NBK539811/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/anaesthesia/catheter-related-bloodstream-infection-prevention-and-response/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anaesthesia/catheter-related-bloodstream-infection-prevention-and-response/