What are the risks of permicath (permanently implanted catheter) infection and how can they be mitigated?

Permicath Infection Risks and Prevention Strategies

The most effective strategy to prevent permicath (permanently implanted catheter) infections is implementing a comprehensive bundle approach that includes proper insertion techniques, ongoing maintenance protocols, and appropriate site selection, as these measures can reduce infection rates by up to 80%. 1

Infection Risk Factors

• Permicath-related infections are primarily caused by migration of skin organisms at the insertion site into the cutaneous catheter tract with subsequent colonization of the catheter tip, which is the most common route of infection for permanently implanted catheters 1
• Contamination of the catheter hub contributes substantially to intraluminal colonization of long-term catheters 1
• The most common pathogens causing permicath infections include:
  • Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus, and Enterococcus species) 1
  • Gram-negative microorganisms (account for approximately 20% of infections) 1
• Catheter material plays a significant role in infection risk - catheters made of polyvinyl chloride or polyethylene are less resistant to microbial adherence compared to those made of Teflon, silicone elastomer, or polyurethane 1
• Duration of catheterization directly correlates with infection risk - the longer a catheter remains in place, the higher the risk of biofilm formation and subsequent infection 2

Infection Prevention Strategies

Proper Insertion Techniques

• Use maximal sterile barrier precautions during insertion, including cap, mask, sterile gloves, gown, and sterile full-body drape 1
• Perform hand hygiene before catheter insertion and maintenance 1
• Use >0.5% chlorhexidine skin preparation with alcohol for antisepsis at the insertion site 1
• Select the optimal insertion site - subclavian placement is preferred over jugular or femoral sites in adults to reduce infection risk 1
• Implement ultrasound guidance during insertion to reduce the number of catheter placement attempts 1

Ongoing Maintenance

• Educate and designate only trained healthcare personnel for catheter care 1
• Use sutureless securement devices with needle-less connectors 1
• Apply sterile, transparent dressings and change them according to protocol 1
• Use chlorhexidine-impregnated dressings at the exit site and exchange them weekly to decrease bacterial colonization 3
• Maintain aseptic technique during all catheter manipulations 1
• Consider specialized "IV teams" for catheter care, as they have shown unequivocal effectiveness in reducing infection rates 1

Catheter Selection

• Choose catheters with the minimum number of lumens necessary for patient management 1
• Select catheters made of materials that resist microbial adherence (Teflon, silicone elastomer, or polyurethane) 1
• Consider antimicrobial-impregnated catheters for patients at high risk of infection 3

Management of Permicath Infections

• For suspected catheter-related bloodstream infections (CRBSI), obtain blood cultures from both the catheter and a peripheral vein 1
• If the patient has unexplained sepsis or erythema at the catheter site, the catheter should be removed as soon as possible 1
• Complete device removal is the definitive management strategy whenever feasible, as colonization significantly increases the risk of clinical infection 3
• If catheter removal is not feasible, consider "locked-in" antibiotic therapy (retaining antibiotics in the catheter lumens) in addition to systemic antibiotics 2
• For empiric therapy, select antimicrobials based on likely pathogens associated with the specific device, such as using vancomycin if MRSA risk is high 3

Special Considerations

• Patients receiving chemotherapy, total parenteral nutrition, or who are neutropenic for a prolonged period are at increased risk for catheter-related infections 1
• The average cost per episode of CRBSI is approximately $45,814, making prevention strategies highly cost-effective 1
• Biofilm formation on catheters can make infections difficult to eradicate and confer inherent resistance to antibiotics 1
• Femoral insertion sites should be avoided when possible due to higher infection rates and increased risk of deep venous thrombosis 1

By implementing these evidence-based prevention strategies and promptly addressing suspected infections, the risk of permicath-related infections can be significantly reduced, improving patient outcomes and reducing healthcare costs.