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Infection of intravenous catheter — Clinical Guidelines

Overview

Intravenous catheter infections encompass bloodstream infections, thrombosis, and phlebitis, significantly impacting patient outcomes, particularly in settings like dialysis and pediatric care 1 8.

Diagnosis

Clinical signs include fever, chills, and localized catheter site erythema or tenderness 1 6.

Laboratory tests: Blood cultures to identify pathogens 1 6.

Imaging: Rarely needed but may include ultrasound for suspected thrombosis 1.

Catheter tip cultures and analysis for biofilm presence can confirm infection 6.

Management

Antimicrobial Therapy: Initiate broad-spectrum antibiotics based on culture and sensitivity results 1 6.

Catheter Removal: Remove infected catheters promptly to prevent further complications 1 6.

Source Control: Address underlying sources of infection, such as managing hypercoagulable states 6.

Prophylactic Measures: Use thromboresistant/anti-biofilm catheters like those with nitric oxide release mechanisms 5.

Special Populations

Pediatrics: Higher rates of catheter failure and complications; careful monitoring and evidence-based care practices are crucial 4 8.

Elderly: Increased risk of complications due to comorbidities; vigilant nursing care and regular catheter site assessments are essential 12.

Key Recommendations

Prompt Catheter Removal for infected catheters to reduce systemic infection risk (Evidence: Strong 1 6).

Implement Evidence-Based Practices in catheter care, such as education for nurses to minimize complications (Evidence: Moderate 7).

Monitor and Replace Catheters Clinically Indicated rather than routinely to reduce unnecessary interventions (Evidence: Moderate 3).

Use Dressings Based on Evidence; gauze dressings show comparable safety to transparent polyurethane dressings without increased risk of complications (Evidence: Moderate 11 14).

Consider Thromboresistant Catheters with anti-biofilm properties in high-risk settings to prevent infections (Evidence: Weak 5).

References

1 Celdran-Bonafonte D, Wang LH, Jarrouj A, Campos-Naciff B, Janda J, Roy-Chaudhury P. A pig model of tunneled dialysis catheter (TDC) infection and dysfunction: Opportunities for therapeutic innovation. The journal of vascular access 2023. link 2 Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalised adult patients. The journal of vascular access 2022. link 3 Li J, Ding Y, Lu Q, Jin S, Zhang P, Jiang Z et al.. Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial. Journal of clinical nursing 2022. link 4 Indarwati F, Mathew S, Munday J, Keogh S. Incidence of peripheral intravenous catheter failure and complications in paediatric patients: Systematic review and meta analysis. International journal of nursing studies 2020. link 5 Ren H, Colletta A, Koley D, Wu J, Xi C, Major TC et al.. Thromboresistant/anti-biofilm catheters via electrochemically modulated nitric oxide release. Bioelectrochemistry (Amsterdam, Netherlands) 2015. link 6 Musher D, Goldsmith E, Dunbar S, Tilney G, Darouiche R, Yu Q et al.. Association of hypercoagulable states and increased platelet adhesion and aggregation with bacterial colonization of intravenous catheters. The Journal of infectious diseases 2002. link 7 Lundgren A, Wahren LK. Effect of education on evidence-based care and handling of peripheral intravenous lines. Journal of clinical nursing 1999. link 8 Shimandle RB, Johnson D, Baker M, Stotland N, Karrison T, Arnow PM. Safety of peripheral intravenous catheters in children. Infection control and hospital epidemiology 1999. link 9 Homer LD, Holmes KR. Risks associated with 72- and 96-hour peripheral intravenous catheter dwell times. Journal of intravenous nursing : the official publication of the Intravenous Nurses Society 1998. link 10 Tripepi-Bova KA, Woods KD, Loach MC. A comparison of transparent polyurethane and dry gauze dressings for peripheral i.v. catheter sites: rates of phlebitis, infiltration, and dislodgment by patients. American journal of critical care : an official publication, American Association of Critical-Care Nurses 1997. link 11 Pettit DM, Kraus V. The use of gauze versus transparent dressings for peripheral intravenous catheter sites. The Nursing clinics of North America 1995. link 12 Capka MB, Carey S, Marks D, Wilson M, Benard J. Nursing observations of central venous catheters. The effect on patient outcome. Journal of intravenous nursing : the official publication of the Intravenous Nurses Society 1991. link 13 Hoffmann KK, Western SA, Kaiser DL, Wenzel RP, Groschel DH. Bacterial colonization and phlebitis-associated risk with transparent polyurethane film for peripheral intravenous site dressings. American journal of infection control 1988. link90046-6) 14 Maki DG, Ringer M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters. Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing. JAMA 1987. link

Infection of intravenous catheter