Tunnel infection

Background

• A type of central line infection characterized by signs of soft tissue infection extending along the tunneled portion of the catheter

Case Definition

IDSA

• Tenderness, hyperemia, and/or induration that extends >2 cm from the exit site and along the subcutaneous tunnel
• May or may not be associated with bacteremia

CDC

• Tenderness, erythema, or site induration >2 cm from the catheter site along the subcutaneous tract of a tunneled catheter, in the absence of concomitant bloodstream infection

Management

• Send cultures of any drainage and send blood cultures
• Remove catheter, without exchange over a wire
• Insert replacement catheter at distant site
• Antibiotics
  • Cover Gram-positive and Gram-negative organisms, and adjust based on culture results
  • Without bacteremia, treat for 10 to 14 days
  • With bacteremia, see central line-associated bloodstream infection for management