Running head: PREVENTION OF BLOODSTREAM INFECTION

Prevention of Bloodstream Infection

Amanda Klawinski
University of South Florida

PREVENTION OF BLOODSTERAM INFECTION

Introduction and Background Information

The night nurse was giving report about a patient. She had given the admitting story and
then said that the patient was very stable, all labs looked good, and then gave the information
about his intravenous access. He had three peripheral I.V.s, only one of which she was using and
then she said that he had a femoral central line still that had his maintenance fluids attached to it.
After report I asked my preceptor what criteria did the patient need to meet to keep his central
line because having one when it isnt needed just increases the patients risk for infection. She
said the patient needed to meet typically one or more of the following criteria to be in need of
one: patient is on total parenteral nutrition, be on three percent saline, have multiple antibiotics
running, no peripheral venous access due to trauma, have third spacing, be on vasopressors,
measuring central venous pressure, or needed one for fluid resuscitation.
The Problem
The patient was doing great. His labs looked really good, he was very stable, and he
already had three peripheral I.V.s in which only one was being used. The patient had no
abnormal presentation and based off all information it was unnecessary to put him at more risk
for infection when there was no need for the central line unless there was a special reason that
the doctors wanted him to have it. The maintenance fluids could be attached to one of the other
two peripheral lines available, so that was not an issue. The issue at hand was that a patient was
being put at risk for a bloodstream infection when he did not need to be.
Status
The nurse listed off the criteria that the patient needed to meet in order to get a central
line on their floor. The patient did not meet any of the criteria because he was no longer on TPN.
He was on normal saline, had no antibiotics running, he had three peripheral I.V.s, he did not
have third spacing, was not on any vasopressors, was not having his central venous pressure
measured, and was not in need of fluid resuscitation because his labs were all within normal
limits. The only thing left to do was confirm with the provider that there was no longer a need for

PREVENTION OF BLOODSTERAM INFECTION

it because the longer a central line is left in the greater the risk for infection. Each dressing
change increases the risk further for possible infections. An infection in the femoral artery could
be very critical to the patients health because it would be a bloodstream infection that wont just
be localized to one place, but go all over the body.
Action to Take
At that point I chose to do something right then and there by asking about the central line
and getting to the bottom of why he would need it. Waiting would only increase the chance for
infection and at that point he was not showing any signs, so it made since to keep him that way.
One major goal is always to prevent infection and if the patient doesnt meet the criteria, is
stable, had good lab values, and has multiple peripheral lines to access then having the central
line removed to decrease his risk for infection is the right decision. The provider for the patient
also agreed that the patient did no longer meet the criteria and therefore, it was removed.
Evidence-Based Practice
In 2002 the Centers for Disease Control said that annually there are approximately 1.7
million hospital acquired infections and from those that 98, 987 deaths occurred and out of that
number approximately 30 percent of them were due to bloodstream infections (Ippolito, Larson,
Furuya, Liu, & Seres, 2015). There was a comparison done with an electronic database to see
what factors put patients who have a central line at more risk for infection (Ippolito et al., 2015).
The results were that parenteral nutrition was associated with an increase in central lineassociated bloodstream infections (Ippolito et al., 2015). The patient had been on parenteral
nutrition, but it had been discontinued and according to this study that had actually put him at a
higher risk for a bloodstream infection. That being said now that he was no longer on TPN or
anything else that required a central line the best thing to do was to discontinue it to decrease the
patients risk for infection.
Conclusion

PREVENTION OF BLOODSTERAM INFECTION

The decision to bring up the issue of the central line to the nurse was definitely the right
decision to make. It was only putting the patient at more risk since the patient did not meet the
criteria to have one. The provider for the patient also verified that a central line was no longer
necessary. The outcome for this situation was desired because by bringing up the issue to the
nurse and provider the central line was removed and in that removal the patient was now at a
lower risk for infection.

PREVENTION OF BLOODSTERAM INFECTION

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