6 month-old male on home parenteral nutrition presents to emergency department with sudden onset altered mental status. On exam, patient is non-responsive, temperature 35 degrees Celsius, HR 180, blood pressure undetectable, skin is modeled. The central line site is clear. Blood cultures have been obtained, and broad spectrum IV antibiotics have been initiated. They gave several IV fluid boluses and are planning on starting medications to support his blood pressure. The emergency department paged HPN on-call for advice about line removal.
What is your advice?
A. Remove central line if C-reactive protein is elevated.
B. Remove central line if white blood cell count is elevated.
C. Remove central line is blood culture turns positive.
D. Remove central line as soon as possible
E. Remove central line only if blood cultures are persistently positive on appropriate antibiotics.
The correct answer is d. In any HPN patient presenting with signs of septic shock, central line removal should be considered as soon as possible. Deferring to laboratory studies or waiting for a positive blood culture may lead to dangerous delay in care.