Focus Topic Intravascular Catheter-Related Infections

Infections and sepsis caused by intravascular catheters in veterinary medicine (ICRI and CABSI)

Vascular catheters are of great importance in the care and treatment of patients. On the one hand, they are important for the administration of medication and infusions. On the other hand, they pose an infection risk, as microorganisms can penetrate the skin through the puncture site and lead to local infections. Microorganisms can, however, also enter the bloodstream and thus spread hematogenously, which can sometimes result in a primary sepsis infection.

In human medicine, septicemia with positive blood culture accounts for approximately 10 percent of all nosocomial infections. Intravascular catheters are thereby directly or indirectly involved in causing a sepsis infection with a mortality rate of 25 percent. ^[1]

In veterinary medicine, there is considerably less data on this topic. The complication rate for peripheral venous catheters (PVC) is up to 46 percent ^[2] while for central venous catheters (CVC), it is 39 percent^. ​[3] A distinction is made between mechanical or inflammatory/infectious complications. Phlebitis is one of the most common complications. ^​[4] Such phlebitis may be caused by mechanical, chemical or infectious agents. ^[5] Bacterial colonization of catheters in veterinary medicine is a major problem and has been described with incidences of 15 to 39.6 percent in the literature. In some cases, multi-resistant pathogens have been detected in 46 percent of positive cultures. ^{​[2, 6–9]}

In human medicine, peripheral venous catheters have long been ignored as a cause of sepsis, as the risk is significantly lower than is the case with CVC. However, the application rate is significantly higher, meaning that the number of avoidable catheter-associated septicemias is presumably still high. 

ICRI or sepsis becomes apparent when the pathogens have found access to the catheter tip. In principle, pathogens can gain access via the outer catheter surface or through the catheter lumen. ^[10]

The most common causes are interruptions in asepsis during catheter placement and handling, e.g., when infusion sets are changed or medication is administered. In human medicine, it is recommended that patients be connected to an infusion and that the set-up be left as a closed system for up to 96 hours. Each disconnection increases the risk of contamination of the catheter. In veterinary medicine, frequent disconnection is common, as animal patients cannot carry the infusion system around with them without great effort. Other causes might include contaminated medication, puncture-site contamination caused by secretions or excrements, or contamination caused by unprotected Luer-Lock connections. ^{[11, 12]}

Here, too, we know from human medicine that the infection rates can be reduced through targeted prevention measures as well as further training. ^[13]

Good process hygiene when placing and handling catheters, administering infusion therapies and preparing and administering drugs play a decisive role in prevention.

^{[​1] Pittet D Wenzel RP. Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995; 155(11):1177-84.
[​2] Crisi PE, Santis F de, Aste G, Tiscar PG, Mosca F, Gasparini A et al. Inflammatory, Mechanical and Infectious Complications Associated with Peripheral Intravenous Catheters in Dogs and Cats: A risk factor analysis. Vet Sci 2022; 9(3).
[​3] Adamantos S, Brodbelt D, Moores AL. Prospective evaluation of complications associated with jugular venous catheter use in a veterinary hospital. J Small Anim Pract 2010; 51(5):254-7.
[​4] Simpson SE, Zersen KM. Incidence and type of peripheral intravenous catheter complications documented in hospitalised dogs. J Small Anim Pract 2022.
[​5] Helm RE. Accepted but Unacceptable: Peripheral IV Catheter Failure: 2019 follow-up. J Infus Nurs 2019; 42(3):149-50.
[​6] Guzmán Ramos PJ, Fernández Pérez C, Ayllón Santiago T, Baquero Artigao MR, Ortiz-Díez G. Incidence of and associated factors for bacterial colonization of intravenous catheters removed from dogs in response to clinical complications. J Vet Intern Med 2018; 32(3):1084-91.
[​7] Jones ID, Case AM, Stevens KB, Boag A, Rycroft AN. Factors contributing to the contamination of peripheral intravenous catheters in dogs and cats. Vet Rec 2009; 164(20):616-8.
[​8] Marsh-Ng ML, Burney DP, Garcia J. Surveillance of infections associated with intravenous catheters in dogs and cats in an intensive care unit. J Am Anim Hosp Assoc 2007; 43(1):13-20.
[​9] Seguela J, Pages J-P. Bacterial and fungal colonisation of peripheral intravenous catheters in dogs and cats. J Small Anim Pract 2011; 52(10):531-5.
[​10] Cooper GL, Schiller AL, Hopkins CC. Possible role of capillary action in pathogenesis of experimental catheter-associated dermal tunnel infections. J Clin Microbiol 1988; 26(1):8-12.
[​11] Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen (Prevention of vascular catheter-associated infections in pre-terms and neonates): Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (Recommendation of the Robert Koch Institute’s Commission on Hospital Hygiene and Infection Prevention (KRINKO)) . Bundesgesundheitsbl 2018; 61(5):608-26.
[​12] Prävention von Infektionen, die von Gefäßkathetern ausgehen (Prevention of infections caused by vascular catheters): Teil 2 – Periphervenöse Verweilkanülen und arterielle Katheter Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (Part 2 – Periphervenous indwelling cannulae and arterial catheters. Recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute). Bundesgesundheitsbl 2017; 60(2):207-15.
[​13] Dettenkofer M. Praktische Krankenhaushygiene und Umweltschutz (Practical hospital hygiene and environmental protection). 4th ed. Berlin, Heidelberg: Springer Berlin Heidelberg; 2018. (Springer Reference Medicine).​}