Tunnelled line exit site infection

• Swab exit site.
• Assess tunnelled track for erythema, tenderness or induration and if present see guideline below on tunnel-track infections.
• Take blood cultures
• If low MRSA risk:

• If penicillin allergy/high MRSA risk:

  Doxycycline 100mg PO BD (1st day) then OD for 14 days

Tunnelled line track infections (Hickman lines and other tunnelled lines)

• Take samples:
  • Blood culture through the line
  • Peripheral blood cultures
  • Swab of exit site
• Remove line if possible
• Vancomycin IV 1g bd (or 1g od if >65 years) (Monitor blood levels; adjust dose if renal impairment) 
• Change to Flucloxacillin IV 1-2g qds if methicillin sensitive Staphylococcus aureus is isolated.
• Review antibiotics with culture results
• If difficult infection, discuss with microbiology regarding the addition of a second agent.

Notes

• Line-associated bacteraemia due to Staph.aureus should be treated by a minimum of 14 days antibiotic therapy after line removal

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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