O5 · Infection from lines
Risk Surgery and intensive care
Definition
Intravenous lines and other devices can carry germs into the body.- Long dwell time
- poor hygiene
- contaminated hubs
- weak immunity
- Redness
- pus at the site
- fever
- chills
📋 Scenario
A patient has had a central line for nine days, and hub care has been inconsistent.
Subjective (S): "My line site is fine."
Objective (O): Central line day 9; site clean and dry; temperature 36.9 C; hub handled without gloves twice; low white cell count.
Assessment tools for this scenario: CP-SURG Post-op & Critical Care Check
Validated scales to consider: RASS, CPOT, Aldrete
**CarePath diagnosis:** Infection from lines related to long dwell time and poor hygiene (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Use aseptic technique. | Sterile technique and clean hands keep germs from entering the bloodstream through the line. Strict hygiene every time the line is handled is the most important protection. |
| Clean hubs. | Cleaning hubs before each use removes germs that can be pushed into the line. Gloves and a thorough scrub of the hub before each access stop contaminated hubs causing bloodstream infection. |
| Check the site. | Regular site checks find redness, swelling, pus or pain early, before infection spreads. This matters more because his low white cell count weakens defenses. |
| Remove unneeded lines. | The longer a line stays in, the higher the infection risk, so removing lines that are not needed removes the pathway for germs. |
| Report infection. | Reporting fever, chills or site changes quickly allows early cultures and treatment, which is important with a low white cell count. |
**Expected outcomes**
- No fever, redness, or pus at the line site.
- Hub cleaned with the correct technique every time.
- Any early sign of infection reported at once.
- Line removed as soon as it is no longer needed.
**Linking the data to the diagnosis**
The patient says, 'My line site is fine.' The central line is on day 9, the site is clean and dry, temperature is 36.9 C, but the hub was handled without gloves twice and the white cell count is low. There is no infection, so a risk statement fits, not an actual infection. It rests on long dwell time and poor hygiene, with weak defenses adding to the danger. The plan aims to prevent infection, and if signs appear, to recognize them early, take cultures, start treatment and remove the line if needed.
CarePath diagnosis
Infection from lines related to long dwell time and poor hygiene (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Use aseptic technique. | Sterile technique and clean hands keep germs from entering the bloodstream through the line. Strict hygiene every time the line is handled is the most important protection. |
| 2. Clean hubs. | Cleaning hubs before each use removes germs that can be pushed into the line. Gloves and a thorough scrub of the hub before each access stop contaminated hubs causing bloodstream infection. |
| 3. Check the site. | Regular site checks find redness, swelling, pus or pain early, before infection spreads. This matters more because his low white cell count weakens defenses. |
| 4. Remove unneeded lines. | The longer a line stays in, the higher the infection risk, so removing lines that are not needed removes the pathway for germs. |
| 5. Report infection. | Reporting fever, chills or site changes quickly allows early cultures and treatment, which is important with a low white cell count. |
Expected outcomes
- No fever, redness, or pus at the line site.
- Hub cleaned with the correct technique every time.
- Any early sign of infection reported at once.
- Line removed as soon as it is no longer needed.
Linking the data to the diagnosis
The patient says, 'My line site is fine.' The central line is on day 9, the site is clean and dry, temperature is 36.9 C, but the hub was handled without gloves twice and the white cell count is low. There is no infection, so a risk statement fits, not an actual infection. It rests on long dwell time and poor hygiene, with weak defenses adding to the danger. The plan aims to prevent infection, and if signs appear, to recognize them early, take cultures, start treatment and remove the line if needed.