Welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas, and we're going to talk about central line infections.

And we're continuing the theme of the new year that we're going to try to stick to things that we use every day.

So we give you a little dioresis and now we're giving you line infections. So Josh,

it's not uncommon that we'll talk about new fevers. The line's been in a few days. Maybe the site

looks horrible. And I have to find, I don't know about you, but I find there's a lot of variance

amongst myself and my colleagues about what we should do in these circumstances. So it's good.

We're going to stick straight to it. So we all have in these circumstances. So it's good. We're going to

straight to it. So we all have the same approach. Good luck with that. Tudgeon. So we'll start

off with prevention. We'll talk about diagnostic approach. Then we'll talk about the management.

And from there, we'll throw in a little tidbits of specific scenarios. So, Josh,

let's get straight into it. The physiology. I had an intact skin, and now I poke a hole in it. So how

do lines get infected? Long story short, the early lines are probably due to contamination from the

skin. So when you put the line in, maybe there's some contamination that goes on, or there's a

superficial bacterial thing going on. It kind of tracks along the path of the line. The late line infections

seem to be more endovascular seeding of the line. So the line may develop a biofilm. Bacteria can

kind of just stick to that thing. Or the hub, essentially like the internal components of the line,

may become colonized and infected. So different mechanisms and unfortunately these lines can get infected well after they're placed.

And one thing that I wasn't paying attention to, but now I'm going to for two reasons, is one, nurses with protocols have TPA on there.

So if a port goes down, maybe they're giving TPA like every day, which A is expensive and B is not without

risk. And the more important thing is why did the port go down? So if the line's been in, say, a week

and now one of the Lumens is down, this is a big factor, isn't it? 100%. Yeah. I think it's one thing

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