Prevention of vascular catheter-related infections

Infection is the most common serious complication of intravascular catheters. Most cases of catheter-related infection are caused by staphylococci that originate either from the skin of the patient and migrate along the external surface of the catheter or from a contaminated catheter hub and migrate along the internal surface of the catheter. Major risk factors predisposing to catheter-related infection include prolonged duration of catheter placement, frequent manipulation of the catheter, use of thrombogenic catheter material, location of the catheter, and use of occlusive transparent plastic dressings. A number of measures have been reported in prospective, randomized clinical trials to protect against vascular catheter-related infection. This paper summarizes the clinical efficacy of various preventive measures, such as placement and maintenance of vascular catheters by a skilled infusion therapy team, institution of maximal sterile barriers, use of silver-impregnated subcutaneous cuff, antimicrobial coating of catheters with either antibiotics or antiseptics, use of an antiseptic catheter hub, application of topical disinfectants, and flushing catheters with the combination of antimicrobial and antithrombotic agents. (C) 1999 Elsevier Science B.V. All rights reserved.