Prevention of catheter-related infection: which catheter, which access and which insertion technique should be chosen?

Abstract

Central venous and arterial catheters are commonly used in critically ill patients. Such catheters may entail mechanical and infectious complications. Catheter-related infections result in a high rate of morbidity and mortality and elevated costs. Numerous contributions have been made in the prevention of catheter-related infections, and the present review focuses on which catheter, which access and which insertion technique should be used. Regarding vascular access, some sites have shown higher risk of catheter-related bloodstream infections (CRBSI), such as the internal jugular site with tracheostomy and the femoral access site. With respect to which catheter should be used, there is evidence that catheters impregnated with rifampicin-(minocycline or miconazole) and chlorhexidine-silver sulfadiazine reduce the risk of CRBSI. These impregnated catheters could be considered in the following circumstances: vascular access channelling with increased risk of CRBSI (such as the internal jugular with tracheostomy or femoral access), immunocompromised patients or patients with disorders of skin integrity. Regarding the choice of insertion technique, there is evidence that ultrasound guidance may decrease cannulation failure and complication rates.