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Catheter Related Blood Stream Infections

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

Is it possible to be infected via a catheter in a hospital? If so, why does this happen, what are the potential consequences, and how is this problem diagnosed and treated?

About Catheters

To get blood from a patient, or get fluids into a patient, you need tubes! Such a simple tool is often forgotten, but ever so necessary in a hospital.

An intravascular catheter is a tube-like device that is placed within a blood vessel. Intra- means within, and -vascular refers to a blood vessel. While a catheter can be placed in the blood vessels that carry oxygenated blood (arterial), most often they are placed into the ones that carry deoxygenated blood (venous). These are your veins - the ones you can sometimes see on the surface of your body as bluish lines.

These catheters can be placed just about anywhere, depending on the patient's physiological status and the medical professional's needs. Some are placed in an arm, others in the neck, and so forth. Since venous catheters are more commonly used, we'll focus on them in this lesson.

Catheters are placed into the venous system for three main reasons:

  • To draw blood from the patient in order to run tests
  • To give fluids to a patient to keep their water and electrolyte (salt and mineral) balance in check
  • To give medication to a patient that cannot be given orally or needs to be delivered more quickly

Some of these catheters are taken out within hours of being placed, and others are left in place for far longer, sometimes for weeks. Can you ever get an infection from a catheter? Let's investigate.

What is CRBSI?

In some cases, microscopic organisms like bacteria and fungi may travel from the outside world, down the catheter, and into the patient's bloodstream. This results in a catheter-related bloodstream infection (CRBSI). A CRBSI is one of the most common causes of nosocomial bacteremia. 'Nosocomial' means an infection acquired in a hospital; bacteremia simply means that bacteria have invaded the bloodstream and are now present within the patient as a result.

The main microorganisms that cause CRBSI are Staphylococci bacteria, but Enterococci bacteria and aerobic, gram-negative bacilli and yeast can infect patients as well.

Causes

CRBSI occurs because the bacteria either migrate into the bloodstream by moving along the outside of the catheter, or they make their way inside the lumen (open inner space) of the catheter via the hub, which is the part of the catheter that sticks out of the patient.

Many things should be done to prevent this from happening, including:

  • Only allowing trained personnel to insert the catheter.
  • Using proper aseptic technique to insert the catheter. This includes washing of hands, wearing appropriate gear like sterile gloves, and using the appropriate chemicals to keep any instrumentation and the skin surface as clean as possible prior to insertion.
  • Keeping the skin, and any material such as dressing, around the catheter very clean thereafter.
  • Replacing or removing the catheter when necessary.

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