Twenty-five Years of Advances in Vascular Access: Bridging Research to Clinical Practice

Abstract

Vascular access has become a key component for a multitude of IV therapies, including parenteral nutrition. Access of the central venous system has been long recognized for its associated complications of infection, thrombosis, and occlusion. Over the past 25 years, clinical practice based on research and innovation has attempted to decrease complication rates and therefore improve the safety of vascular access. This article highlights the research and its influence on catheter care procedures, technology, and education that has led to advances in vascular access. An improved understanding of the pathophysiology associated with catheter-related complications and an ongoing evaluation of new treatment modalities has provided clinicians today with new options for improved patient care and the ability to preserve vascular access options for patients.

Get full access to this article

View all access options for this article.

References

Dudrick SJ, Rhoads J. New horizons for intravenous feeding. JAMA . 1971;215:939– 949.

Crnich CJ, Maki D. The promise of novel technology for the prevention of intravascular device-related bloodstream infection, I: pathogenesis and short-term devices. Clin Infect Dis . 2002 ;34:1232– 1242.

Polderman KH, Girbes A. Central venous catheter use, part 2: infectious complications. Intensive Care Med . 2002 ;28:18– 28.

O'Grady NP, Alexander M, Dellinger EP, et al; for the Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol . 2002;23:759– 769.

Harbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect . 2003;54:258– 266.

Crnich CJ, Maki DG. The promise of novel technology for the prevention of intravascular device related bloodstream infection, II: long-term devices. Clin Infect Dis . 2002 ;34:1362– 1368.

Elliott TS. Intravascular-device infections. J Med Microbiol . 1988;27:161– 167.

Gristina AG, Jennings R, Naylor PT, Myrvik QN, Webb LX. Comparative in vitro antibiotic resistance of surface-colonizing coagulase-negative staphylococci. Antimicrob Agents Chemother . 1989 ;33:813– 816.

Costerton JW, Irvin R, Cheng KJ. The bacterial glycocalyx in nature and disease. Annu Rev Microbiol . 1981 ;35:299– 324.

10.

Sheth NK, Franson T, Sohnle PG. Influence of bacterial adherence to intravascular catheters on in-vitro antibiotic susceptibility. Lancet . 1985;2:1266– 1268.

11.

Krzywda EA, Andris DA, Edmiston CE. Catheter infections: diagnosis, etiology, treatment, and prevention. Nutr Clin Pract . 1999 ;14:178– 190.

12.

Raad II, Hohn DC, Gilbreath BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol . 1994 ;15:231– 238.

13.

Sherertz, RJ, Ely EW, Westbrook DM, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med . 2000 ;132:641– 648.

14.

Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet . 1991;338:339– 343.

15.

Hibbard JS. Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review. J Infus Nurs . 2005;28:194– 207.

16.

Garland JS, Alex CP, Mueller CD, et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics . 2001 ;107:1431– 1436.

17.

Segura M, Alvarez-Lerma F, Tellado JM, et al. Advances in surgical technique: a clinical trial on the prevention of catheter related sepsis using a new hub model. Ann Surg . 1996 ;223:363– 369.

18.

Luna L, Masdeu G, Parez M, et al. Clinical trial evaluating a new hub device designed to prevent catheter related sepsis. Eur J Clin Microbiol Infect Dis . 2000 ;19:655– 662.

19.

Raad II, Hanna HA. Intravascular catheter-related infections: new horizons and recent advances. Arch Intern Med . 2002 ;162:871– 878.

20.

Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med . 2000 ;132:391– 402.

21.

Attar A, Messing B. Evidence-based prevention of catheter infection during parenteral nutrition. Curr Opin Clin Nutr Metab Care . 2001;4:211– 218.

22.

Veenstra DL, Saint S, Sullivan SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA . 1999 ;281:261– 267.

23.

Maki DG, Stolz SM, Wheeler S, Mermel LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med . 1997 ;127:257– 266.

24.

Raad I, Darouiche R, Hachem R, Mansouri M, Bodey GP. The broad-spectrum activity and efficacy of catheters coated with minocycline and rifampin. J Infect Dis . 1996 ;173:418– 424.

25.

Pai MP, Pendland SL, Danziger LH. Antimicrobial-coated/bonded and -impregnated intravascular catheters. Ann Pharmacother . 2001;35:1255– 1263.

26.

Messing B, Peitra-Cohn S, Debure A, Beliah M, Bernier JJ. Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients. JPEN J Parenter Enteral Nutr . 1988 ;12:185– 189.

27.

Krzywda EA, Andris DA, Edmiston CE Jr, Quebbeman EJ. Treatment of Hickman catheter sepsis using antibiotic lock technique. Infect Control Hosp Epidemiol . 1995 ;16:596– 598.

28.

Bagnall-Reeb H. Evidence for the use of the antibiotic lock technique. J Infus Nurs . 2004 ;27:118– 122.

29.

Rijnders BJ, Van Wijngaerden E, Vandecasteele SJ, Stas M, Peetermans WE. Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial. J Antimicrob Chemother . 2005 ;55:90– 94.

30.

Berrington A, Gould FK. Use of antibiotic locks to treat colonized central venous catheters. J Antimicrob Chemother . 2001 ;48:597– 603.

31.

Bestul MB, Vanden Bussche HL. Antibiotic lock technique: review of the literature. Pharmacotherapy . 2005 ;25:211– 227.

32.

Segarra-Newnham M, Martin-Cooper EM. Antibiotic lock technique: a review of the literature. Ann Pharmacother . 2005 ;39:311– 318.

33.

Schwartz C, Henrickson KJ, Roghmann FK, Powell K. Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms. J Clin Oncol . 1990;8:1591– 1597.

34.

Henrickson KJ, Axtell RA, Hoover SM, et al. Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: a randomized, multicenter, double-blind trial. J Clin Oncol . 2000;18:1269– 1278.

35.

Jurewitsch B, Lee T, Park J, Jeejeebhoy K. Taurolidine 2% as an antimicrobial lock solution for prevention of recurrent catheter-related bloodstream infections. JPEN J Parenter Enteral Nutr . 1998 ;22:242– 244.

36.

Koldehoff M, Zakrzewski JL. Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients. Int J Antimicrob Agents . 2004 ;24:491– 495.

37.

Shah CB, Mittelman MW, Costerton JW, et al. Antimicrobial activity of a novel catheter lock solution. Antimicrob Agents Chemother . 2002;46:1674– 1679.

38.

Dannenberg C, Bierbach U, Rothe A, Beer J, Korholz D. Ethanol-lock technique in the treatment of bloodstream infections in pediatric oncology patients with Broviac catheter. J Pediatr Hematol Oncol . 2003;25:616– 621.

39.

Metcalf S, Chambers ST, Pithie AD. Use of ethanol locks to prevent recurrent central line sepsis. J Infect . 2004 ;49:20– 22.

40.

Ball PA, Brokenshire E, Parry B, et al. Ethanol locking as a possible treatment for microbial contamination of long-term central venous catheters [letter]. Nutrition . 2003 ;19:570 .

41.

Yamamoto AJ, Solomon JA, Soulen MC, et al. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol . 2002 ;13:77– 81.

42.

Lederle FA, Parenti CM, Berskow LC, Ellingson KJ. The idle intravenous catheter. Ann Intern Med . 1992 ;116:737– 738.

43.

Stephens LC, Haire W, Kotulak GD. Are clinical signs accurate indicators of the cause of central venous catheter occlusion? JPEN J Parenter Enteral Nutr . 1995 ;19:75– 79.

44.

Andris DA, Krzywda E. Central venous catheter occlusion: successful management strategies. Med Surg Nurs . 1999 ;8:229– 236.

45.

Klerk CP, Smorenburg SM, Buller HR. Thrombosis prophylaxis in patient populations with a central venous catheter: a systematic review. Arch Intern Med . 2003 ;163:1913– 1921.

46.

Raad II LM, Khalil SA, Costerton JW, Jam C, Boday GP. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA . 1994 ;271:1014– 1016.

47.

Wechsler RJ, Spirn P, Conant EF, Steiner RM, Needleman L. Thrombosis and infection caused by thoracic venous catheters: pathogenesis and imaging findings. AJR Am J Roentgenol . 1993 ;160:467– 471.

48.

Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol . 2003;21:3665– 3675.

49.

Polderman KH, Girbes A. Central venous catheter use, part 1: mechanical complications. Intensive Care Med . 2002 ;28:1– 17.

50.

Parvez B, Parmar N, Chan AK. Trimming of peripherally inserted central venous catheters may increase the risk of thrombosis. Thromb Res . 2004 ;113:175– 177.

51.

Allen AW, Megargell JL, Brown DB, et al. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol . 2000 ;11:1309– 1314.

52.

Cadman A, Lawrance JA, Fitzsimmons L, Spencer-Shaw A, Swindell R. To clot or not to clot? That is the question in central venous catheters. Clin Radiol . 2004 ;59:349– 355.

53.

Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol . 2003 ;14:527– 534.

54.

Scott W. Central venous catheters: an overview of Food and Drug Administration activities. Surg Oncol Clin North Am . 1995 ;4:377– 393.

55.

Schutz JC, Patel AA, Clark TW, et al. Relationship between chestport catheter tip position and port malfunction after interventional radiologic placement. J Vasc Interv Radiol . 2004 ;15:581– 587.

56.

Petersen J, Delaney JH, Brakstad MR, Rowbotham RK, Bagley CM Jr. Silicone venous access devices positioned with their tips high in the superior vena cava are more likely to malfunction. Am J Surg . 1999 ;178:38– 41.

57.

Forauer AR, Alonzo M. Change in peripherally inserted central catheter tip position with abduction and adduction of the upper extremity. J Vasc Interv Radiol . 2000 ;11:1315– 1318.

58.

Stillman RM, Soliman F, Garcia L, Sawyer PN. Etiology of catheter-associated sepsis: correlation with thrombogenicity. Arch Surg . 1977;112:1497– 1499.

59.

van Rooden CJ, Schippers EF, Barge RM, et al. Infectious complications of central venous catheters increase the risk of catheter-related thrombosis in hematology patients: a prospective study. J Clin Oncol . 2005 ;23:2655– 2660.

60.

Couban S, Goodyear M, Burnell M, et al. Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer. J Clin Oncol . 2005;23:4063– 4069.

61.

Verso M, Agnelli G, Bertoglio S, et al. Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: a double-blind, placebo-controlled, randomized study in cancer patients. J Clin Oncol . 2005 ;23:4057– 4062.

62.

Marin MG, Lee JC, Skurnick JH. Prevention of nosocomial bloodstream infections: effectiveness of antimicrobial-impregnated and heparin-bonded central venous catheters. Crit Care Med . 2000 ;28:3332– 3338.

63.

Bern M, Lokich JJ, Wallach SR, et al. Very low doses of warfarin can prevent thrombosis in central venous catheters. Ann Intern Med . 1990;112:423– 429.

64.

Carlo JT, Lamont JP, McCarty TM, Livingston S, Kuhn JA. A prospective randomized trial demonstrating valved implantable ports have fewer complications and lower overall cost than nonvalved implantable ports. Am J Surg . 2004 ;188:722– 727.

65.

Hurtubise MR, Bottino JC, Lawson M, McCredie KB. Restoring patency of occluded central venous catheters. Arch Surg . 1980 ;115:212– 213.

66.

Svoboda P, Barton RP, Barbarash OL, et al. Recombinant urokinase is safe and effective in restoring patency to occluded central venous access devices: a multiple-center, international trial. Crit Care Med . 2004;32:1990– 1996.

67.

Haire WD, Atkinson JB, Stephens LC, Kotulak GD. Urokinase versus recombinant tissue plasminogen activator in thrombosed central venous catheters: a double-blinded, randomized trial. Thromb Haemost . 1994;72:543– 547.

68.

Davis SN, Vermeulen L, Banton J, Schwartz BS, Williams EC. Activity and dosage of alteplase dilution for clearing occlusions of venous-access devices. Am J Health Syst Pharm . 2000 ;57:1039– 1045.

69.

Timoney JP, Malkin JB, Leone DM, et al. Safe and cost effective use of alteplase for the clearance of occluded central venous access devices. J Clin Oncol . 2002 ;20:1918– 1922.

70.

Ponec D, Irwin D, Haire WD, et al. Recombinant tissue plasminogen activator (alteplase) for restoration of flow in occluded central venous access devices: a double-blind placebo-controlled trial–the Cardiovascular Thrombolytic to Open Occluded Lines (COOL) efficacy trial. J Vasc Interv Radiol . 2001 ;12:951– 955.

71.

Deitcher SR, Fese MR, Kproff DM, et al. Safety and efficacy of alteplase for restoring function in occluded central venous catheters: results of the cardiovascular thrombolytic to open occluded lines trial. J Clin Oncol . 2002;20:317– 324.

72.

Dillon PW, Jones GR, Bangall-Reeb HA, et al. Prophylactic urokinase in the management of long-term venous access devices in children: a children's oncology group study. J Clin Oncol . 2004 ;22:2718– 2723.

73.

Andris DA, Krzywda E, Schulte W, et al. Pinch-off syndrome: a rare etiology for central venous catheter occlusion. JPEN J Parenter Enteral Nutr . 1994;18:531– 533.

74.

Bagnall-Reeb H. Diagnosis of central venous access device occlusion. Implications for nursing practice. J Intraven Nurs . 1998;21(5 suppl):S115– S121.

75.

Breaux CW, Duke D, Georgeson KE, Mestre JR. Calcium phosphate crystal occlusion of central venous catheters used for total parenteral nutrition in infants and children: prevention and treatment. J Pediatr Surg . 1987;22:829– 832.

76.

Hadaway L. Managing vascular access device occlusions, part 2 [editorial]. Nursing . 2000 ;30:14 .

77.

Holcombe BJ, Forloines-Lynn S, Garmhausen LW. Restoring patency of long-term central venous access devices. J Intraven Nurs . 1992;15:36– 41. Erratum, 1993;16:55.

78.

Shulman RJ, Reed T, Pitre D, Laine L. Use of hydrochloric acid to clear obstructed central venous catheters. JPEN J Parenter Enteral Nutr . 1988;12:509– 510.

79.

Pennington CR, Pitre AD. Ethanol lock in the management of catheter occlusion. JPEN J Parenter Enteral Nutr . 1987 ;11:507– 508.

80.

Werlin SL, Lausten T, Jessen S, et al. Treatment of central venous catheter occlusions with ethanol and hydrochloric acid. JPEN J Parenter Enteral Nutr . 1995 ;19:416– 418.

81.

McHugh GJ, Wild D, Havill JH. Polyurethane central venous catheters, hydrochloric acid and 70% ethanol: a safety evaluation. Anaesth Intensive Care . 1997 ;25:350– 353.

82.

Shulman RJ, Barrish J, Hicks MJ. Does the use of hydrochloric acid damage silicone rubber central venous catheters? JPEN J Parenter Enteral Nutr . 1995;19:407– 409.

83.

Silberzweig JE, Sacks D, Khorsandi AS, Bakal CW; and the Society of Interventional Radiology Technology Assessment Committee. Reporting standards for central venous access. J Vasc Interv Radiol . 2003 ;14:S443– S452.

84.

Berenholtz SM, Pronovost P, Lipsett PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med . 2004 ;32:2014– 2020.

85.

Barton AJ, Danek G, Johns P, et al. Improving patient outcomes through CQI: vascular access planning. J Nurs Care Qual . 1998;13:77– 85.

86.

Ngo A, Murphy S. A theory-based intervention to improve nurses' knowledge, self-efficacy, and skills to reduce PICC occlusion. J Infus Nurs . 2005;28:173– 181.

87.

Martone WJ, Gaynes R, Horan TC, et al. National Nosocomial Infections Surveillance (NNIS) semiannual report, May 1995: a report from the National Nosocomial Infections Surveillance (NNIS) system. Am J Infect Control . 1995;23:377– 385.

88.

National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control . 2004;32:470– 485.