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Infected CVC Replacement Site — FRCA Final MCQ

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EasyIntensive Care MedicineInfected CVC Replacement SiteFRCA Final

A 55-year-old man in ICU requires central venous access. He has a right-sided subclavian CVC that is infected. A new CVC is needed. What is the safest site for the new CVC?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Right femoral vein

When replacing an infected CVC, the new line must be placed at a DIFFERENT site (not exchanged over a guidewire through the infected tract, as this perpetuates the infection). A contralateral site (left IJ or left subclavian) is preferred. The femoral site has a higher infection rate for long-term use but is acceptable short-term. The infected line should be removed, tip sent for culture, and blood cultures taken. NICE CG139 recommends a new site rather than guidewire exchange for confirmed CLABSI.

Reference: NICE – 2017 – CG139 CVC infection; ICS – 2023 – CLABSI guidelines