Infection is the most common late complication of central venous cannulation, occuring in 5% of patients with central venous catheters (150,000 to 250,000 cases of catheter-related blood stream infection [CRBSI] per year). The overall mortality of patients with nosocomial bloodstream infections (not restricted to CRBSI) is ~ 35%, and the cost of one CRBSI can exceed $50,000
Employ aseptic technique during placement, which includes full sterile drape, sterile gown and gloves, hat and mask. Use the subclavian vein when possible (although direct comparisons of SC and IJV have not been made). Single lumen catheters are associated with a lower infection rate and should be used when clinically feasible. Heparin-bonded catheters reduce both thrombosis and infection. Antibiotic-impregnated catheters reduce in incidence of catheter colonization and blood stream infection.
Employ a BioPatch (on both the central venous and systemic arterial catheter sites) – the 2×2 factorial randomized controlled trial comparing chlorhexidine-impregnated sponges and less frequent dressing changes to traditional management of intravascular catheters included these sponges on the arterial catheters, and showed that chlorhexidine-impregnated sponges on both the arterial and central venous catheters lowers CRBSI from 1.4:1000 to 0.6:1000 catheter days.
Implementation of a central line checklist has been shown to be extremely efficacious at reducing the incidence of CRBSI.
Silver-impregnated subcutaneous cuffs and routine, scheduled catheter site changes are not supported by any data.
Catheter-Related Blood Stream Infection (CRBSI)
Epidemiology
- Incidence: ~ 5% per person with central venous catheter
- Mortality: unknown, however the mortality rate of all patients with a nosocomial bloodstream infection is ~ 35%
- Cost: up to $50,000 per infection
Prevention
- Technique: aseptic (sterile full body drape, gown, gloves. Hat, mask)
- Site: subclavian preferred (although IJV and SC never directly compared)
- Catheter: single lumen (if possible), heparin-bonded, antibiotic impregnated
- Biopatch: proven in multiple studies (although always placed on the arterial line as well)
- Expeditious Removal: remove CVCs as soon as not needed
- Checklist: shown to dramatically reduce the incidence of CRBSI
References
- Jean-François Timsit, Carole Schwebel, Lila Bouadma, Arnaud Geffroy, Maïté Garrouste-Orgeas, Sebastian Pease, Marie-Christine Herault, Hakim Haouache, Silvia Calvino-Gunther, Brieuc Gestin, Laurence Armand-Lefevre, Véronique Leflon, Chantal Chaplain, Adel Benali, Adrien Francais, Christophe Adrie, Jean-Ralph Zahar, Marie Thuong, Xavier Arrault, Jacques Croize, Jean-Christophe Lucet, Dressing Study Group Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA: 2009, 301(12);1231-41 PubMed Link
- Sean M Berenholtz, Peter J Pronovost, Pamela A Lipsett, Deborah Hobson, Karen Earsing, Jason E Farley, Shelley Milanovich, Elizabeth Garrett-Mayer, Bradford D Winters, Haya R Rubin, Todd Dorman, Trish M Perl Eliminating catheter-related bloodstream infections in the intensive care unit. Crit. Care Med.: 2004, 32(10);2014-20 PubMed Link
- Sean M Berenholtz, Peter J Pronovost, Pamela A Lipsett, Deborah Hobson, Karen Earsing, Jason E Farley, Shelley Milanovich, Elizabeth Garrett-Mayer, Bradford D Winters, Haya R Rubin, Todd Dorman, Trish M Perl Eliminating catheter-related bloodstream infections in the intensive care unit. Crit. Care Med.: 2004, 32(10);2014-20 PubMed Link
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