Antibiotics should generally be withheld in febrile patients with intravenous catheters and no other clear source of infection pending the results of blood cultures.
Exceptions include immunosuppressed or critically ill patients, patients with valve replacement or other hardware in place, or instances where there is purulence at the catheter site.
Two sets of blood cultures should be drawn with at least one (preferably both) from peripheral sites. Blood cultures drawn through non-tunneled catheters are more likely to yield contaminates.
Catheter removal is strongly recommended for infections with S. aureus, yeast, and Psuedomonas, as the chance of catheter salvage is low and the risks of ongoing infection can be high.
Catheters associated with tunnel infections cannot be salvaged and must be removed.
Catheter salvage can be considered in CLABSI caused bu coagulase-negative staphylococci if the patient is clinically stable. Infectious diseases consultation is advised.
When catheter salvage is attempted, antibiotics should be given through the infected line.