From the Guidelines
Internal jugular vein infections associated with central lines require prompt removal of the infected catheter and appropriate antibiotic therapy, as the risk of catheter-related bloodstream infections (CRBSIs) is high, with a daily infection rate about 20 times higher than with peripheral catheters 1.
Key Considerations
- The infected central line should be removed as soon as possible and a new line placed at a different site if continued vascular access is needed.
- Empiric antibiotic therapy should be started immediately with vancomycin (15-20 mg/kg IV every 8-12 hours) plus an antipseudomonal agent such as cefepime (2g IV every 8 hours) or piperacillin-tazobactam (4.5g IV every 6 hours) 1.
- Blood cultures should be obtained before starting antibiotics.
- The duration of antibiotic therapy typically ranges from 7-14 days, depending on the causative organism and clinical response.
- For uncomplicated infections, 7 days may be sufficient, while complicated infections with persistent bacteremia or metastatic foci require 14 days or longer.
Prevention Strategies
- Strict adherence to aseptic technique during insertion
- Chlorhexidine skin preparation
- Regular assessment of line necessity with prompt removal when no longer needed
- Use of antimicrobial coated catheters, such as rifampicin-based impregnated catheters, which have been shown to reduce the risk of CRBSIs 1
- Use of tunneled and implanted catheters, which have been associated with a lower risk of infection compared to non-tunneled catheters 1
Important Notes
- The most common pathogens responsible for CRBSIs are Staphylococcus species (particularly S. aureus and coagulase-negative staphylococci), followed by gram-negative bacilli and Candida species 1.
- Patients should be monitored for signs of septic thrombophlebitis, endocarditis, or other complications.
- The use of ultrasound-guided venepuncture and maximal barrier precautions during insertion can also help reduce the risk of CRBSIs 1.
From the Research
Internal Jugular Vein Infection and Central Line
- Internal jugular vein thrombosis (IJVthr) is a potentially life-threatening disease that can be caused by various factors, including central vein catheterization 2.
- The risk of infection is higher with jugular vein catheterization compared to subclavian vein catheterization, with infection rates of 6.1 per 1000 catheter-days in jugular vein catheterization and 3.8 per 1000 catheter-days in subclavian vein catheterization 3.
- The most common microorganisms associated with catheter-related bloodstream infection (CR-BSI) are coagulase-negative staphylococci (CoNS) and Staphylococcus aureus, which can colonize the skin at the insertion site and contaminate the catheter tip 4.
- Lemierre syndrome is a rare and potentially fatal entity characterized by septic emboli from thrombosis of the internal jugular vein, often caused by Staphylococcus aureus or other bacteria 5, 6.
- Symptoms of internal jugular vein thrombosis include neck pain, headache, swelling, erythema, and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever 2.
- Diagnosis of internal jugular vein thrombosis can be made using ultrasound of the neck, which is a quick, economic, and noninvasive tool 2.
- Treatment of internal jugular vein thrombosis typically involves anticoagulation therapy and antimicrobial treatment, and may require surgical intervention in some cases 5, 6.