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. Furthermore, transferring a patient from a transplantation unit to another intensive care unit may also increase the risk of another infection due to exposure to multidisciplinary teams.

However, it is the priority intention and focus of the transplant team to keep the patient under close supervision of a trained team throughout the transplant period.

What are the causes of central line infection?

Patients undergoing bone marrow transplants have weakened immune systems, making them highly susceptible to infections. However, with proper care from healthcare workers and family members, it is possible to prevent such infections. Patients who take good care of themselves live a healthy life without any complications. The following are some reasons why central line infections occur.

Secondly, it is the primary responsibility of the nursing staff and doctors to give teaching to patients and families regarding central line precautions and handling while bathing or doing other tasks.

Poor hand hygiene of the staff handling the central line in the transplant unit

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 through hand hygiene and personal protective equipment. 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. All aseptic and cleans tecneques should be carried out to prevent any foreign objects, which can cause infection.

Touching the central line by the patients :

Most of the patients, especially the pediatric population, touch the central line with their hands. It increases the risk of central line-associated bloodstream infections (CLABSI)

What are the signs of central line infection?

Central line infection has the following signs and symptoms.

•  Frequent High-grade fever with chills, mostly after starting IV fluids and medicine
• 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) due to dehydration and blood infection
• 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 can 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 transplantation. First of all, it is necessary to inject strong cytotoxic drugs called conditioning chemotherapy. This chemotherapy aims to clear the defective marrow of the patient and to create space for new marrow.

This chemotherapy could not be given through a peripheral cannula to avoid extravasation. Furthermore, this line is used to give other medications, whole blood and blood products, stem cells, or whole bone marrow.

Moreover, this line is used to draw multiple blood samples, which are necessary daily during a transplant.

How long is the central line needed?

A central line is needed from the day of transplant until the day of discharge, to 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 and exposed 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 guidelines of the Centers for Disease Control (CDC). Hence, central line care is very important during bone marrow transplant and chemotherapy treatment.

Important steps for dressing:

The dressing of the line should be done with aseptic techniques. Hand hygiene should be performed before dressing change. The new joiners should be trained regarding the handling of the central line. A senior or expert staff member should demonstrate the dressing and handling protocols.

To avoid central line-associated infection, care during line insertion and maintenance care is very important. Moreover, the infectionist is onboard for daily monitoring of the central line.