Intravascular Catheter Management and Infection Prevention

Intravascular catheters, including central venous catheters and peripherally inserted central catheters, are integral to modern healthcare for administration of fluids, medications and parenteral nutrition. However, their use carries risks of mechanical complications such as misplacement, thrombosis and catheter occlusion, as well as infectious complications exemplified by central line-associated bloodstream infections. Pathogenesis often involves biofilm formation on catheter surfaces, which shields microbes from host defences and systemic antibiotics. Prevention strategies centre on aseptic insertion techniques, ultrasound guidance to reduce mechanical trauma, rigorous maintenance bundles incorporating skin antisepsis with chlorhexidine–alcohol and appropriate dressing changes, and the use of lock solutions to maintain patency and deliver antimicrobial or anticoagulant agents. Recent advances include antimicrobial-impregnated materials, standardised care pathways to ensure high compliance with insertion and maintenance bundles, and integrated surveillance programmes that inform quality improvement cycles. Effective catheter management not only reduces patient morbidity and mortality, but also yields significant cost savings and supports global efforts to combat antimicrobial resistance.

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Intravascular Catheter Management and Infection Prevention publication trend

The graph below shows the total number of articles in intravascular catheter management and infection prevention across all publications each year (not limited to Nature Index journals).

Technical terms

Central venous catheter: A flexible tube inserted into a large vein, typically in the neck, chest or groin, to deliver therapies directly into the central circulation.

Peripherally inserted central catheter (PICC): A long catheter introduced via a peripheral vein, advanced until its tip resides in a central vein, used for prolonged intravenous access.

Central line-associated bloodstream infection (CLABSI): A laboratory-confirmed bloodstream infection in patients with a central venous catheter, where the catheter is the only plausible source of infection.

Biofilm: A structured community of microorganisms adherent to surfaces and encased in a self-produced extracellular matrix that confers protection against antibiotics and immune responses.

Ultrasound guidance: The use of real-time sonographic imaging to visualise blood vessels and guide needle and catheter placement to reduce insertion-related complications.

Catheter lock solution: A small volume of antimicrobial or anticoagulant fluid instilled into the catheter lumen during periods of non-use to maintain patency and prevent microbial colonisation.

References

1. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Critical Care (2017).
2. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infection Control and Hospital Epidemiology (2022).
3. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Annals of Intensive Care (2020).
4. Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. Critical Care (2018).
5. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit. Nursing Research and Practice (2015).