Catheters Give Life but Sometimes Take It

There is a “tremendous” amount of work being done to decrease CVCs in intensive care units, but there should be more focus on at-risk populations, says Trish Perl, MD, MSc, professor of medicine, pathology and epidemiology at Johns Hopkins Medical University, and an epidemiologist at Johns Hopkins medical institutions in Baltimore. The vulnerable populations she speaks of include dialysis patients, patients with long-term central lines, or who are undergoing chemotherapy. “In some of these groups the bundle may need to be changed and adapted to the risk factors that these patient populations are affected by,” Perl says.

Why Catheters are Dangerous

Forty-eight percent of ICU patients have CVCs, and that adds up to a whopping 15 million CVC days per year in ICUs.¹ Approximately 5.3 central line infections occur per 1,000 catheter days in ICUs, and deaths range from 14,000 to 28,000 per year.¹

How do infectious organisms use catheters to invade the body? When the catheter is inserted, it breaks the skin and this creates a convenient path for organisms to enter the patient’s bloodstream. Skin antisepsis with proper technique can’t eliminate all organisms in the lower layers of the epidermis, and that means the catheter has access to these organisms as it passes through the skin.²

The danger doesn’t stop there. Medication administration, flushing, and tubing or cap changes require catheter manipulation and can introduce microorganisms to the lumen. Hub manipulation is the most common source of infection in long-term catheters but can also spur CR-BSI in short-term catheters.²