Central Line Associated Blood Stream Infection (CLABSI)

m Bookmark and Share

ANA/APIC logos

ANT 9/2015

Types of vascular-access catheters

Choice of catheter should be based on the intended purpose of the line and projected duration of use.

  • Nontunneled central venous catheters (CVCs). These lines are inserted percutaneously, with the tip resting in a central vein. They’re used for longer-term I.V. therapy with vesicants and irritants, large-volume resuscitation, and invasive monitoring. These catheters are the type most commonly associated with central line–associated bloodstream infections (CLABSIs). The Centers for Disease Control and Prevention (CDC) recommends avoiding use of the femoral vein in adults because of the higher infection rate. It also recommends using the subclavian site unless the patient has advanced renal disease and needs to avoid the risk of stenosis at a future dialysis catheter site.
  • Pulmonary artery catheters. These lines are inserted through an introducer catheter in a central vein, with the tip floating in the pulmonary artery. Used to monitor pressures within the heart, they have similar CLABSI rates as other nontunneled CVCs; however, the subclavian site has a lower risk. During insertion, use a sterile sleeve on this catheter to reduce infection risk.
  • Peripherally inserted CVCs. Used when therapy is expected to last more than 6 days, these catheters are inserted through the basilic, cephalic, or brachial vein, with the tip in the superior vena cava. They have lower CLABSI rates than nontunneled CVCs.
  • Tunneled CVCs. Implanted into the internal jugular, subclavian, or femoral vein, tunneled CVCs have a cuff below the skin that helps prevent migration of organisms down the catheter track. This gives them a lower CLABSI rate than nontunneled CVCs.
  • Totally implantable catheters. Implanted in the subclavian or internal jugular vein, these lines have a subcutaneous port that’s accessed with a needle. Totally implantable catheters have the lowest CLABSI risk of all central lines.
  • Umbilical catheters. These lines are inserted into the umbilical artery or vein; CLABSI risk is similar in both vessels. CDC recommends dwell times not exceed 5 days for an arterial catheter or 14 days for a venous umbilical catheter.

Non-central line catheters, such as peripheral venous, peripheral arterial, and midline catheters, rarely are associated with CLABSI.

From ANT, September 2015 Vol. 10 No. 9

By the Numbers

  • About 41,000 bloodstream infections strike hospital patients with central lines each year
  • About 37,000 bloodstream infections happen each year to kidney dialysis patients with central lines
  • Of patients who get a bloodstream infection from having a central line, up to 1 in 4 die
  • However, by using evidence based infection prevention & control steps:
    • Between 2008 and 2014, CLABSIs in acute care hospitals decreased by 50%
    • In long-term acute care hospitals (LTACHs), between 2013-2014, reported CLABSIs decreased by 9%

Bundles, Guidelines & Toolkits