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
- 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
- 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
- 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%
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