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In contrast, tunnel infections usually present with erythema or swelling extending beyond the exit site, fever, or absent exit site. Pain or tenderness is usually absent or minimal. The exit site may be normal, if the infection is limited to the subcutaneous tissue. If the infection extends into the deep subcutaneous tissue, it may present with a palpable mass. The exit site may or may not be red or erythematous. The catheter may not have an exit site and/or may be covered by a dressing. A tunnel infection is generally presumed based on signs of inflammation but may be confirmed with a needle aspiration of the tunnel; culturing the tunnel may be done in a suspected CLABSI or suspected exit site infection. Culture and sensitivity of the tunnel is required.
Exit site infection: A well-maintained exit site is sterile and free of erythema, edema, or discharge. If the exit site is erythematous, edematous, or purulent, it is presumed to be an infection and is culture-positive. The exit site may be associated with pain or tenderness. The exit site may be normal, if the infection is limited to the skin. If the infection is deep, it may present as a mass, and the exit site may be red or erythematous, or covered by a dressing. The exit site may or may not be associated with inflammation. The exit site may be culture-positive or culture-negative.
Catheter-related bloodstream infection: The infection of the blood stream caused by bacteria introduced through an intravascular catheter such as a central venous catheter or a subcutaneous tunneled catheter, usually occurring at or near the exit site of the catheter. It is typically associated with catheter colonization and inflammation, fever, chills, local erythema, and purulent discharge at the catheter exit site. Most catheter-related bloodstream infections are community acquired, but hospital acquired are also possible. Most catheter-related bloodstream infections occur in patients receiving long-term hemodialysis. 827ec27edc