Preventive Strategies for Intravascular Catheter-Related Infections

Abstract

Millions of intravascular catheters are purchased each year by hospitals and clinics, placing many patients at risk for serious catheter-related infections. This chapter summarizes the rapidly expanding body of literature concerning prevention of intravascular catheter-related infections in the hope of reducing the risk posed to present and future patients. Prophylaxis with vancomycin or teicoplanin during central venous catheter insertion does not reduce the incidence of catheter-related bloodstream infection. The addition of prophylactic vancomycin to flush solutions or total parenteral nutrition solutions significantly reduces the incidence of catheter-related bloodstream infection; however, use of systemic antimicrobial agents to prevent intravascular catheter-related infections is not recommended. Administering very low doses of warfarin reduces thrombosis due to long-term central venous catheters. Use of prophylactic heparin by bolus infusion or when it is added to intravenous solutions does not significantly reduce the risk of central venous catheter-related bloodstream infection. Prophylactic heparin significantly reduces the incidence of catheter-related central venous thrombosis in patients with central venous and pulmonary artery catheters. A number of different strategies can be used to prevent serious intravascular catheter-related infections.