Clabsi

Overview

A CLABSI (say "CLAB-see") is a bloodstream infection that can happen when someone has a central line. A central line is a thin, soft tube placed into a large vein — often in the neck, chest, arm, or groin — so that medicines, fluids, or liquid food can go straight into the blood, and blood can be taken without new needle sticks each time. It can stay in for days or weeks. Germs from the skin, or from hands that touch the line, can get onto the tube or into its opening and travel into the bloodstream. That is a CLABSI. The name stands for "central line-associated bloodstream infection."

CLABSIs used to be one of the most common infections caught in hospital. Rates have dropped a great deal in the last 20 years because hospitals now follow strict step-by-step safety checklists when a line is put in and when it is cared for. They are rare in people who do not have a central line.

Anyone with a central line can get a CLABSI, at any age. The risk is higher for babies and children in intensive care, adults in intensive care, people having chemotherapy or long courses of antibiotics, people on dialysis, and people who need liquid nutrition through a line. Older adults, people with diabetes, and people whose immune system is weaker are also more at risk.

Symptoms

Common symptoms

• Fever, often with chills or shaking
• Redness, warmth, swelling, or soreness where the line enters the skin
• Pus, oozing, or bleeding from the line site
• Feeling tired, achy, or generally unwell, like having flu
• A fast heartbeat or feeling dizzy when standing up
• Feeling sick to the stomach, or not wanting to eat
• Sweating or clammy skin

Symptoms in children

• Fever, or a baby who feels unusually hot or cold
• Being very sleepy, floppy, or hard to wake
• Poor feeding, or fewer wet nappies than usual
• Crying more than usual, or being hard to comfort
• Redness, swelling, or oozing at the line site

Symptoms in older adults

• New confusion or a sudden change in alertness — this can be the first sign
• A mild fever, or sometimes no fever at all
• Feeling much weaker or more unsteady than usual
• A fall, or trouble walking that is new
• Loss of appetite and feeling more tired than normal

Causes

Main causes

• Germs living on the skin around the line get past the skin and into the blood
• Germs on the hands of staff, family, or the patient touch the connection points (the hubs) when medicines are given
• Germs from another part of the body travel along the outside or inside of the tube
• The line stays in longer than it needs to
• Moisture or dirt trapped under the dressing
• Many breaks in the line for medicines or blood tests, which give germs more chances to get in

Risk factors

• Being in an intensive care unit
• A line that has been in place for a long time
• Having more than one tube or channel in the line
• A line placed in the groin rather than the chest or arm
• A weakened immune system, such as from chemotherapy, transplant medicines, or a long illness
• Diabetes, poor nutrition, or poor circulation
• Skin that carries a lot of bacteria, or heavy sweating
• Crowded hospital wards or busy periods when hand hygiene steps may be missed

When to see a doctor

See a doctor urgently if:

• Any fever or chills in a person with a central line — call your care team or go to the nearest emergency department straight away
• Redness, swelling, or pus at the line site
• The line becomes loose, leaks, or looks damaged
• The dressing falls off or becomes wet
• Feeling faint, very dizzy, or unusually sleepy

Book a routine appointment if:

• Mild redness or itching at the site without fever
• Questions about how to shower or bathe with the line
• Worry about the line at home, or wanting to practice line care with a nurse
• Feeling low in mood or anxious about having the line

Diagnosis

A doctor or nurse will ask about your symptoms, take your temperature and blood pressure, and look closely at the line and the skin around it. If they think the line may be the source of an infection, they will take blood samples. Often they take blood from the line itself and also from a vein in your arm, so the two can be compared. Treatment may start before the results come back.

Tests that may be done

• Blood cultures — blood samples checked in a lab to see if germs grow, and which kind
• A full blood count to look for signs of infection
• Other blood tests, such as markers of inflammation or acid levels in the blood
• A swab of the skin around the line site
• Sometimes a heart scan or other imaging if the team wants to check for spread of infection

What to expect at your appointment

Blood culture results usually take 24 to 72 hours, so you may be given treatment while you wait. You may need to stay in hospital for monitoring, and you may have blood tests repeated to check that the treatment is working. Your team will explain each step as it happens.

Treatment

The main treatment is antibiotics given directly into a vein to fight the infection, along with fluids and close monitoring. Sometimes the central line needs to be taken out and a new one placed in a different spot, because germs can hide on the tube. Most people start to feel better within a day or two of starting treatment.

Self-care at home

• Keep the dressing clean and dry, and follow your team's advice on showering
• Do not touch the line, the dressing, or the caps unless a nurse has taught you how
• Wash your hands well before and after any contact with the line
• Check the site once a day, using a mirror if needed, for redness, swelling, or oozing
• Take your temperature if you feel unwell, and write it down
• Ask staff to clean the connection points before giving any medicine
• Keep your care team's contact details where you can find them quickly

Medical treatments

Treatment usually happens in hospital. You will be given antibiotics through a vein, often for one to two weeks depending on the germ and how unwell you are. Your team will give fluids, watch your temperature, blood pressure, and blood tests, and may give medicines to support your blood pressure if it drops. Often the central line is removed and a new line is put in a different place so that treatment can continue safely. In some cases the line can stay if the team decides it is safe. Some people need extra scans or a longer course of treatment if the infection has spread.

When is surgery considered?

Surgery is not usually needed. Occasionally a small procedure is done to remove a line that cannot be pulled out at the bedside, or to place a new line under X-ray guidance. Some people with infection that has spread to a heart valve may need specialist heart care.

Living with this condition

Many people go home with a central line and carry on with normal life with a few changes. You will have the dressing changed on a set schedule, usually by a nurse, and medicine may be given through the line at home. Plan your week around these visits, keep spare dressings and contact numbers handy, and keep the line tucked inside clothing so it does not catch on things.

Lifestyle tips

• Wash your hands often, and ask visitors to do the same
• Keep pets away from the line and wash your hands after being around animals
• Do not swim or take long baths unless your team says it is safe
• Avoid lifting heavy weights with the arm that has the line, if the line is in your arm
• Keep the line covered when you are outdoors or doing messy tasks
• Tell any dentist, nurse, or doctor you see that you have a central line

Diet and exercise

Eating well helps your body fight infection and heal. Try regular meals with protein — such as beans, eggs, fish, chicken, or lentils — plus fruit and vegetables, and drink enough water. Gentle movement, like short walks, helps circulation and mood. Ask your team what level of activity is safe for you, especially while the line is in place.

Mental health and emotional wellbeing

Having a line and recovering from an infection can bring worry, poor sleep, and a sense of being "medicalised." Some people feel anxious about touching the line or fear getting another infection. These feelings are common and worth talking about. Tell your team how you are feeling — counselling, relaxation techniques, and talking with others who have had a line can all help. If at any point you feel hopeless or have thoughts of harming yourself, please reach out to your local crisis support service or emergency number right away.

Prevention

Yes — CLABSIs are among the most preventable hospital infections. Hospitals use a set of steps called a "care bundle": clean hands, a fully sterile setup when the line is placed, a strong antiseptic skin cleaner, a full sterile drape, and a daily check of whether the line is still needed. After that, clean dressings, scrubbing the connection points before every use, and prompt removal of the line when it is no longer needed all lower the risk. Patients and families can help by asking: "Have you cleaned your hands?" and "Do I still need this line?"

Vaccines

There is no vaccine against CLABSI itself. Staying up to date with the vaccines your team recommends — including flu and other routine vaccines — helps you avoid other infections that could make you more vulnerable while you have a line.

Screening programmes

There is no screening test for CLABSI. Instead, staff check the line site and your temperature regularly, and watch for early signs so treatment can start quickly.

Complications

If left untreated

• The infection can spread through the bloodstream and cause sepsis, a whole-body emergency response
• Blood pressure can drop dangerously low, which is called septic shock
• Organs such as the kidneys, lungs, or heart can be affected
• Infection can settle on a heart valve, which needs longer specialist treatment
• Blood clots can form around the line
• Hospital stays become longer, and recovery takes more time

Long-term outlook

The outlook is good for most people when a CLABSI is spotted and treated early. Many people improve within a few days of starting antibiotics, and the line can often be replaced so treatment carries on. Some people need a longer course of treatment or a stay in intensive care, and recovery can take weeks. Being alert to the early signs and speaking up quickly gives you the best chance of a smooth recovery.

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