CLABSI Toolkit - Chapter 1

Chapter 1 reviews the types of central venous catheters and describes the risk factors for and pathogenesis of central line-associated bloodstream infections (CLABSIs). Key points from the monograph and related tools follow. 

Key points include the following:

• Since central venous catheters (CVCs) were introduced, a number of mechanical problems and infections were experienced in the early years, including the recognition of CLABSIs as a serious complication associated with their use.
• The major types of CVCs, based on their design, are non-tunneled catheters, tunneled catheters, implantable ports, and peripherally inserted central catheters.
• Risk factors for CLABSI can be intrinsic (non-modifiable characteristics that patients have, such as age or underlying diseases or conditions) or extrinsic (modifiable factors associated with CVC insertion or maintenance).
• CVCs can become colonized with microorganisms either extraluminally or intraluminally. Extraluminal contamination occurs when the patient’s own skin organisms are introduced during insertion as a result of inadequate pre-procedural skin preparation or migrate within the subcutaneous tract along the surface of the CVC, if the insertion site is unprotected during post-insertion care. Intraluminal contamination occurs when microorganisms are introduced into the catheter lumen while the catheter connector or hub is manipulated or from contamination of the fluid administered through the catheter.
• The catheter material can also influence the development of bloodstream infection.
• Antibiotic resistance is a problem with all common pathogens causing CLABSIs, particularly in intensive care units. 

Types of CVCs

• Comparison of the Major Types of Central Venous Catheters (CVCs) (corresponding to Table 1-1 of CLABSI Monograph Preventing Central Line–Associated Bloodstream Infections: A Global Challenge, A Global Perspective, page 3)
• Pediatric Vascular Access Devices
• CDC – FAQ About Catheters
• Visual Depiction of Each Type of CVC

Risk Factors for CLABSI

• Intrinsic and Extrinsic Risk Factors for CLABSI (corresponding to Table 1-2 of CLABSI Monograph, page 4)
• Intrinsic Risk Factors for CLABSIs and Susceptible Populations (adapted from CLABSI Monograph)

Pathogenesis of CLABSIs

• Routes for Central Venous Catheter Contamination with Microorganisms (corresponding to Figure 1-1 of CLABSI Monograph, page 5)