Central Line Associated Blood Stream Infection Care: Comparative Case Studies.

Abstract

      This comparative case study aimed to explore risk factors, clinical characteristics, treatment outcomes, and nursing management of two critically ill patients with CLABSI. The FANCAS framework, consisting of fluid, aeration, nutrition, communication, activity, and stimulation, was applied together with the nursing process.

      Case 1 was a 60-year-old female with underlying diabetes mellitus, hypertension, asthma, and previous cerebrovascular disease. She was admitted with shock, respiratory failure, diabetic ketoacidosis/hyperosmolar hyperglycemic state, thyroid storm, and acute kidney injury. She required mechanical ventilation, vasopressor therapy, therapeutic plasma exchange, and renal replacement therapy. Blood culture revealed multidrug-resistant Acinetobacter baumannii, and she developed CLABSI with septic shock and multiorgan failure, resulting in death after 19 days of hospitalization.

      Case 2 was a 60-year-old male with hypertension and suspected alcoholic cirrhosis. He was admitted with progressive dysphagia, severe hyponatremia, and proximal muscle weakness with suspected dermatomyositis. Subsequently, he developed respiratory failure, aspiration pneumonia, and severe upper gastrointestinal bleeding requiring mechanical ventilation and central venous catheterization. Multidrug-resistant Acinetobacter baumannii was identified from blood culture, and he developed CLABSI with septic shock and multiorgan failure. After discussion with the family, palliative care was provided, and he was discharged home on day 11 of hospitalization.

      The findings indicated that major risk factors for CLABSI included critical illness with multiple organ dysfunction, mechanical ventilation, immunosuppressive therapy, vasopressor use, repeated catheter manipulation, and multidrug-resistant organism infection. Key nursing roles included adherence to CLABSI bundles, daily assessment of catheter necessity, early recognition of sepsis, prevention of multidrug-resistant organism transmission, critical care management, and family support during end-of-life decision-making.