What is the most appropriate initial intervention for a patient on TPN with a PICC line suspected of having a CLABSI?

For a patient on total parenteral nutrition (TPN) with a peripherally inserted central catheter (PICC) line suspected of having a central line-associated bloodstream infection (CLABSI), the most appropriate initial intervention is to stop the TPN, remove the line, and place a new line for TPN.

This approach is critical because the PICC line is a potential source of infection. Immediate removal of the line is essential to prevent further complications and to effectively manage the suspected infection. By stopping the TPN, you also mitigate the risk of infusing contaminated solutions, which could exacerbate the situation.

In a suspected CLABSI case, the integrity of the vascular access device is compromised, and the priority must be to eliminate the source of the infection. Once the line is removed, a new line can be placed for TPN, ensuring that the patient continues to receive necessary nutritional support while reducing the risk of persistent infection.

While starting antibiotics and sending cultures are important components of managing an infection, they are typically done after the source of infection, in this case, the PICC line, has been removed. Changing the guidewire is not an appropriate intervention here, as it does not address the contaminated line itself.