Central line devices are vital to care, but they are associated with the risk of infection.
Central line associated bloodstream infection (CLABSI) may increase antibiotic exposure, hospital stay, medical costs, and the risk of death.
CLABSI associated with increased risk of death compared to those who do not have this infection.
CLABSI are often preventable and in recent years there has been marked reduction in CLABSI rates.
A catheter related bloodstream infection is defined with signs and symptoms of infection of fever, elevated white blood count, erythema at the catheter site, and when blood culture is positive.
There are four routes for catheter contamination: skin pathogens at the insertion site can enter the cutaneous catheter tract and migrate down the external surface of the catheter towards the tip.
Insertion site contamination can occur also when skin microorganisms increase underneath the catheter dressing overtime.
A second source of catheter contamination can occur when the catheter hub is manipulated and pathogens gain access to the intraluminal surface of the device, which adhere into a biofilm matrix of extracellular polymeric substances allowing for sustained infection and hematogenous spread.
Thirdly, catheters can become contaminatedhematogenously from a secondary bloodstream infection from another focus, such as pneumonia, or UTI.
Bacteria stick to the biofilm that is formed and adhere to the internal lumen of the catheter.
The force mechanism for catheter infection is contaminated infusate taints the catheter.
Most catheter related bloodstream infections (CRBSI) occur now in non-ICU units and in an outpatient setting.
Insertion of a central venous access device (CVAD) can damage the blood vessels walls and potentially introduce microorganisms onto internal and extra luminal catheter surfaces.
Overtime many bacterial strains have evolved abilities to use the host environment to provoke development of their own self-sustaining biofilm colonies.
Biofilms are a common complication of vascular access devices.
Biofilms are identified in 100% of remove CVAD‘s, regardless of whether the clinical infection is present.
Microorganisms existing within biofilms have a greater rate of antibiotic resistance, tolerance to environmental stresses, and reduces susceptibility to host immune attack compared with phenotypes that are single celled bacteria not attached to a biofilm.
Biofilm promotes amplification of the coagulation, cascade and alterations to clot structure, yield in greater mechanical instability and increase likelihood of dislodgment.
Patients with central line associated by bloodstream infection experience, higher mortality rates, and increase ICU lengths of stay and contribute to more than $45,000 in healthcare cost per case compared to patients in the ICU without such infections.
Catheter bloodstream associated infection risk is increased by patient immunocompromise related to hematologic cancers, neutropenia, malnutrition, prolonged hospital stay before device insertion, severe burns, BMI of more than 40, and prematurity in infants.
Increased risk is associated with insertion of the catheter under emergency conditions, incomplete adherence to sterile insertion technique, multiple manipulations of the catheter, low nursing staffing, and failure to remove unnecessary catheters, catheter device characteristics, the site of insertion, the number of lumens, and the indication for use of the catheter.
Locking fluids include saline, heparin, citrate, and various ethanol concentrations – citrate is the only locking fluid associated with reduce central venous catheter and hemodialysis catheter complication rates.
In an adult critical care setting the use of 4% tetrasodium EDTA as a locking fluid reduced the composite outcome of central venous access device complications, compared with control.