Central Line Infection during Bone Marrow Transplant:

Central line infection is a significant issue for healthcare providers working in transplant units and cancer wards or centers. Appropriate handling and care of central lines depend on the expertise and knowledge of nurses working in bone marrow transplant units. In severe cases, central line infections can lead to increased costs and longer hospital stays for patients in transplant units. Additionally, these infections may cause the patient’s death and necessitate a transfer to the intensive care unit due to unstable vital signs.

What are the causes of central line infection?

Patients undergoing bone marrow transplants have a weak immune system, making them highly susceptible to infections. However, with proper care from healthcare workers, it is possible to prevent such diseases. The following are some of the reasons why central-line infections occur.

Poor hand hygiene of staff:

Dirty hands can cause infections in central lines. To prevent this, using a strong hand sanitizer or disinfectant or washing your hands thoroughly with soap and water is highly recommended before handling or touching the central line. It is also advisable to wear surgical gloves when attaching medication, removing IV sets, or drawing blood samples from the line.

Poor patient personal hygiene:

During a bone marrow transplant, patients must maintain good personal hygiene. Patients who do not practice good personal hygiene are at a higher risk of developing infections, such as central line infections. This is because skin flora can easily enter a patient’s central line and cause bloodstream infections. To prevent this, healthcare workers in the transplant unit should take extra care to ensure patients’ hygiene is maintained. Patients should take a daily bath, but before doing so, they should inform their healthcare provider. The central line should be covered according to the hospital policy, which may involve wrapping the line with cling film to prevent exposure to water. By taking these steps, patients can protect their central line from water and reduce the risk of infection.

Drips contaminated with surface flora:

Mishandling of drips and medications administered through the central line must be handled with care. Ports of drips must be cleaned with alcohol swabs before attaching to the central line. Moreover, medication should be prepared in a designated place to avoid any contamination.

What are the signs of central line infection?

Central line infection has the following signs and symptoms.

•  Frequent High-grade fever
• Chills before the fever develops
• Swelling and redness at the insertion site of the catheter
• The patient will experience a drop in blood pressure (hypotension)
• High pulse rate (tachycardia)
• The patient will develop a fever when medicine or intravenous fluid is given through a central line.

How does nursing care impact central line infection?

 Nursing expertise matters a lot while handling patients on chemotherapy or patients undergoing bone marrow transplants. Nurses or health care providers must have special certifications regarding the safe handling of chemotherapeutic drugs or cytotoxic drugs, central line handling, blood and blood product handling, or safe handling of bone marrow or stem cells. Furthermore, healthcare workers in bone marrow transplants should have sound knowledge regarding the side effects of cytotoxic or immunotherapeutic drugs. Moreover, they should know the complications of bone marrow transplants. So, those patients could be managed as quickly as possible.

Why central line important during a bone marrow transplant?

The central line plays an important role in bone marrow transplant. First of all, it is needed to inject strong cytotoxic drugs called conditioning chemotherapy. This chemotherapy could not be given through a peripheral cannula to avoid extravasation. Furthermore, this line is used to give other medications, blood, blood products, stem cells, or whole bone marrow. Moreover, this line is used to draw multiple blood samples, which are necessary during transplant daily.

How long is the central line needed?

A central line is needed from the day of admission till the day of discharge, the patient’s home. The central line must be removed before the patient returns home to avoid infection related to the central line.

How frequently does a central line need a dressing change?

The central line should be manipulated as needed. The more exposure to the environment, the more chances of getting an infection, especially at the insertion site. However, its dressing should be changed as per the Centers for Disease Control (CDC) guidelines. Hence, central line care is very important during bone marrow transplant and chemotherapy treatment. To avoid central line-associated infection, care during line insertion and maintenance care is very important.