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Venous Access Devices – Insertion


Goals/Objectives

  • Indications

  • Techniques

  • Complications

Indwelling Access Devices

Franklin W Huang
Janet L. Abrahm

From Hoffman R, et al: Hematology: Basic Principles and Practice, 6th edition (Churchill Livingstone 2013)

Indications for Removal

Debate continues over cost-effectiveness and salvage rates for catheters once a catheter-related bloodstream infection (CRBSI) is documented.

Exit-Site and Tunnel Infections

Exit-site infections caused by bacteria rarely require catheter removal for resolution, because most (69% to 100%) respond to antibiotics alone. These infections are most often caused by S. epidermidis . Similarly, with implanted ports, infections of the skin pocket have been found to resolve in about 70% of cases without removal of the device.

Tunnel infections or port pocket abscesses, by contrast, usually do not respond to antibiotics; they have been reported to resolve without catheter removal in only 25% to 50% of cases. Catheters were removed from all patients with cutaneous Aspergillus infection, six of whom recovered after antifungal therapy and local wound care (see box on Infectious Indications for Device Removal). Resolution of leukopenia was required for infection resolution. Similarly, Mycobacterium and atypical mycobacterial infection of the tunnel or exit site requires catheter removal as well as excision of infected tissue.

From Mermel LA, Farr BM, Sheretz R, et al: Guidelines for the management of intravascular catheter-related infections. J Intraven Nurs 24:180, 2001; and
Infectious Indications for Device Removal

Venous Access Devices

  • Tunnel infection or port pocket abscess

  • Catheter-related bacteremia caused by Staphylococcus aureus, Xanthomonas spp., Pseudomonas spp., mycobacteria, Bacillus and Corynebacterium species

  • Catheter-related fungemia

  • Septic thrombosis

  • Endocarditis

  • Osteomyelitis

  • Sepsis with signs of shock/persistent end-organ dysfunction

  • Central venous thrombosis

Central Nervous System Access Devices

  • Deep catheter track or epidural space infection

Simon A, Bode U, Beutel K: Diagnosis and treatment of catheter-related infections in paediatric oncology: An update. Clin Microbiol Infect 12:606, 2006.

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