Central Venous Access Device (CVAD) infection e.g. Central/Hickman/PICC line

Please refer to the NHS Forth Valley Suspected/Confirmed Central Venous Access Device (CVAD) Infection Protocol - Adults

N.B. only staff that have been trained & deemed competent in care and maintenance of CVADs, recognised by NHS Forth Valley, should take blood cultures from CVADs

Additional guidance on parenteral nutrition can be found in the NHS Forth Valley Parenteral Nutrition Policy (Adults)

Empirical Treatment Summary

Treatment Duration

Organisms for which retaining the CVAD may be possible

Culture Negative

• CVAD removed
Duration: No further treatment once temperature resolves
• CVAD not removed
Duration: 48 Hours after normalisation of temperature

Culture Negative Staphylococci

• CVAD removed
Duration: No further treatment once temperature resolves
• CVAD not removed
Duration: 7 days total therapy with IV Vancomycin through CVAD

Viridans streptococci / Corynebacterium species

• CVAD removed
Duration: 48 hours after normalisation of temperature
• CVAD not removed
Duration: 7-14 days IV vancomycin therapy through the CVAD

Organisms for which the CVAD must be removed (once safe to do so)

Staphylococcus aureus / Staphylococcus lugdunensis

• Uncomplicated infection
Must remove CVAD
Duration: 14 days IV flucloxacillin or vancomycin counted from day CVAD removed• Complicated infection
Must remove CVAD
Duration: 4 weeks IV flucloxacillin or vancomycin counted from day CVAD removed

B-haemolytic streptococci

• Must remove CVAD
Duration: 7-14 days therapy based on sensitivities

Gram-negative organisms

• Must remove CVAD
Duration: 7-14 days total therapy based on sensitivities

Candida species

• Must remove CVAD
Duration: Minimum 14 days IV Caspofungin counted from day CVAD removed

Mycobacterium species

• Must remove CVAD
Duration: Consult microbiologist will advise