Central venous catheter sepsis.

There are two main routes for a central venous catheter to become infected and to produce septicemia: exogenous contamination from the skin or the hub, or from a contaminated infusate and endogenous seeding of the tip during bacterial and fungal episodes. Depending upon the patient population and medical and nursing care, one or the other mechanism may be involved. It is quite difficult to identify the route of infection in a single instance unless patients are enrolled in an ad hoc study protocol that guarantees the maximum safety in preparation of the solutions, administering them and managing the catheter. In critically ill patients, when the clinical picture is masked and confusing and the diagnosis is extremely difficult, a positive peripheral blood culture, a positive swab on the skin entry of the catheter or occasionally a quantitative culture of microorganisms from central blood that is higher than from peripheral blood dictates the removal or exchange of the catheter. Central venous catheter sepsis is usually resolved with catheter removal; however, in critical patients who still need the catheter in place, the risk of a new percutaneous catheter after removal of a suspected infected catheter must be weighted against the chance of resolving the sepsis by a simple exchange over a guidewire and long term irrigation of the new catheter with antibiotics.