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Central venous catheter-related infections: Types of devices and definitions

INTRODUCTION

Central venous catheters (CVCs) are increasingly used in hospitals to manage critically ill patients. They provide secure access to the central circulation for infusion therapy, nutritional support, hemodynamic monitoring, plasmapheresis and apheresis, and hemodialysis. Unfortunately, infectious complications can result in significant morbidity and mortality. As an example, the case fatality rate for catheter-related bloodstream infections approaches 20 percent [1,2]. Furthermore, nosocomial bloodstream infections, approximately 90 percent of which are catheter-related [3], prolong hospitalization by a mean of seven days and increase medical costs by nearly $12,000 [4].

(See "Definitions and epidemiology of nosocomial intravascular catheter-related (primary) bloodstream infections".)

The types of CVCs and conventional definitions of the types of catheter-related infections will be reviewed here. The clinical issues related to these infections are discussed separately.

TYPES OF CENTRAL VENOUS CATHETERS

Central venous catheters can be inserted percutaneously or surgically.

Percutaneous insertion — Percutaneously-inserted CVCs are the most commonly used central catheters. Most CVCs are inserted centrally into the subclavian, jugular, or femoral veins. However, peripherally inserted central catheters (PICCs) continue to gain in popularity because of the following advantages (table 1): the relative ease of insertion into the cephalic or basilar veins of the antecubital fossa; a low risk of complications; and good patient tolerance [5].
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