What is the risk of Central Line-Associated Bloodstream Infection (CLABSI) with a femoral central line after 10 days?

From the Guidelines

The risk of Central Line-Associated Bloodstream Infection (CLABSI) with a femoral central line after 10 days is significantly increased, with an estimated incidence of 2.5-5.5 per 1,000 catheter-days 1.

Key Factors Contributing to CLABSI Risk

• Prolonged use of femoral lines beyond 10 days is associated with a higher risk of CLABSI, particularly in patients receiving total parenteral nutrition (TPN) or vasopressor therapy 1.
• The use of antimicrobial/antiseptic-impregnated catheters or dressings, such as chlorhexidine gluconate (2%) or povidone-iodine (10%), may help mitigate this risk 1.

CLABSI Prevention Strategies

• Implementing a bundle approach that includes educating and designating only trained health care personnel, hand hygiene, and the use of sterile gloves before catheter insertion can reduce the risk of CLABSI 1.
• Maximal sterile barrier precautions, including the use of a cap, mask, gown, and sterile full-body drape, can also help prevent CLABSI 1.
• Regularly replacing the administration set and needle-less connectors at least every 7 days can further reduce the risk of CLABSI 1.

From the Research

Risk of Central Line-Associated Bloodstream Infection (CLABSI) with a Femoral Central Line

The risk of CLABSI with a femoral central line after 10 days is not explicitly stated in the provided studies. However, some studies provide information on the risk of CLABSI over time:

• A study published in 2021 2 found that the CLABSI rate during the first 30 days a line was in situ was lower than the rate after 30 days (0.51 per 1,000 line days vs. 3.06 per 1,000 line days, respectively).
• Another study published in 2018 3 derived a rule of thumb stating that the risk of CLABSI increases in a quadratic fashion with the increase in catheter dwell-time.

Factors Associated with CLABSI

Several studies identified factors associated with an increased risk of CLABSI, including:

• Catheter dwell-time 2, 3
• Type of catheter (e.g., tunneled or implanted) 4
• Presence of ostomy or wound 4
• Low BMI 4
• Hematologic malignancy 5
• Surgical complexity 5
• Length of ICU stay 5
• Parenteral nutrition 5

CLABSI Rates

The provided studies reported the following CLABSI rates:

• 1.35 per 1,000 line days in pediatric patients with tunneled femoral PICCs 2
• 0.89 per 1,000 catheter days in adult home parenteral nutrition patients 4
• Less than 0.1% in trauma patients with central lines 6