A 68-Year-Old Man with Percutaneous Nephrostomy Tubes Is Brought to the Emergency

A 68-year-old man with percutaneous nephrostomy tubes is brought to the emergency department by his wife because of confusion. The wife says that he is "not his usual self" and responded with nonsensical phrases when she awoke him for breakfast. He has prostate cancer and receives leuprolide injections every 3 months. He appears uncomfortable and diaphoretic. He is oriented to person but not to place or time. His temperature is 36.8°C (98.2°F) , pulse is 124/min, respirations are 22/min, and blood pressure is 76/50 mm Hg when supine. Pulse oximetry on room air shows an oxygen saturation of 96%. In the emergency department, a decision is made to insert a central venous catheter.  In addition to sterile draping during the procedure, which of the following actions would be most likely to prevent intravascular catheter-related infections?

A) Alcohol-based hand scrub prior to beginning the procedure
B) Daily application of topical mupirocin at the catheter site
C) Insertion of the catheter in the femoral vein
D) One dose of intravenous vancomycin prior to catheter insertion
E) Replacement of the catheter every 7 days

Correct Answer:

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