A 35-year-old male is admitted with severe multiple trauma. On hospital day 4, while receiving total parenteral nutrition (TPN), he develops new tachycardia (120 bpm), tachypnea, and fever (38.9°C). The triple-lumen central venous catheter (CVC) insertion site in his right internal jugular vein is erythematous with purulent drainage. What is the essential immediate management?

Answer and explanation

Correct answer: A. Remove catheter, culture tip, and start empiric IV antimicrobials

  1. Step 1: Central Line-Associated Bloodstream Infection (CLABSI) with catheter insertion site purulence or erythema is an indication for immediate catheter removal.
  2. Step 2: The catheter tip (distal 5 cm) should be aseptically clipped and sent for quantitative roll-plate culture, accompanied by paired peripheral blood cultures.
  3. Step 3: Empiric intravenous antibiotics (e.g., Vancomycin covering MRSA and Cefepime/Meropenem covering Pseudomonas) should be initiated.
  4. Step 4: TPN must be discontinued or administered through a newly placed sterile line at a different anatomical site.
Answer
Remove catheter, culture tip, and start empiric IV antimicrobials.
Why not the others: 'Flush with heparin and leave in place' promotes septic thrombophlebitis and persistent bacteremia; 'Paracetamol and continue TPN' ignores septic source control; 'Oral ampicillin' provides inadequate coverage for resistant nosocomial staphylococci and gram-negative rods.

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