What is the point of entry for Central Venous Catheter (CVC) related bloodstream infections?

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DS

Dainyal Siddiqui, MD

Internal Medicine

MJ

Manuel Jimenez, MD

Cardiology

FP

Franz Pierre-Louis, MD

Infectious Disease

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Last updated: February 12, 2025 • View editorial policy

From the Guidelines

The primary point of entry for Central Venous Catheter (CVC) related bloodstream infections is the patient's own skin, accounting for approximately 65% of infections, followed by the hub of the catheter, which is responsible for around 30% of infections 1.

The pathogenesis of CVC-related infections involves the colonization of the insertion site by normal skin flora or pathogenic organisms, which can then spread along the outer surface of the catheter or through the hub 2.

  • Extraluminal spread: In short-term catheters, infections are mainly due to extraluminal spread of bacteria along the outer surface of the catheter.
  • Intraluminal pathway: In long-term indwelling catheters, the intraluminal pathway predominates, with microorganisms embedding into a biofilm on the interior surface of the catheter.

Risk Factors and Prevention

Risk factors for CVC-related infections include high level of skin colonization at the insertion site and the catheter hub/connector, as well as age and male gender 3. Prevention strategies, such as hand hygiene, maximal sterile barrier precautions, and cutaneous antisepsis with chlorhexidine during CVC insertion, are essential to reduce the risk of infection 4.

Common Pathogens

The most commonly identified organisms in catheter-related infections are coagulase-negative staphylococcus, S aureus, Candida species, enteric gram-negative bacilli, and Pseudomonas aeruginosa 1, 5.

From the Research

Point of Entry for Central Venous Catheter (CVC) Related Bloodstream Infections

  • The point of entry for CVC-related bloodstream infections is often linked to the insertion site and the colonization of the skin and catheter tip 6.
  • Skin colonization is an important source for CVC colonization and infection, with high levels of skin colonization at the insertion site predicting catheter tip colonization and possibly subsequent infection 6.
  • The insertion site itself can also play a role, with some studies suggesting that femoral site insertion is associated with a higher rate of bloodstream infection and catheter colonization compared to subclavian and internal jugular sites 7.
  • Risk factors for CVC-related bloodstream infections include: + Age, with older patients being at higher risk for colonization prior to CVC placement 6 + Male gender, with male patients being at particular risk for skin colonization and possibly requiring additional insertion-site care 6 + Baseline colonization and subsequent colonization of the skin at the insertion site 6 + Type of catheter insertion site, with femoral site insertion being associated with a higher rate of bloodstream infection and catheter colonization 7
  • Prevention of CVC-related bloodstream infections involves a combination of evidence-based guidelines and newer technologies, including: + Hand hygiene 8, 9 + Full sterile barrier precautions at insertion 8 + Cutaneous antisepsis with 2% chlorhexidine alcoholic preparation 8 + Use of chlorhexidine-impregnated dressings 8 + Daily evaluation of the need for the device 9 + Proper maintenance and care of the catheter, including dressing management and bathing practices 9

References

8
Research

Management and Prevention of Central Venous Catheter-Related Infections in the ICU.

Seminars in respiratory and critical care medicine, 2019

9
Research

Central Line Care and Management: Adopting Evidence-Based Nursing Interventions.

Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses, 2021

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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