Central Venous Catheters in the United States: An Overview

What is a Central Venous Catheter?
A central venous catheter, also known as a central line, is a flexible tube placed in a large vein near the heart. Common insertion sites include the subclavian, internal jugular, or femoral veins. Central lines allow for rapid infusion of fluids, medications, nutrients or blood products directly into the circulatory system. They also provide access for hemodynamic monitoring through central venous pressure measurement.

There are different types of Central Venous Catheters depending on their intended use and duration. Short-term, non-tunneled catheters remain in place for a few days during acute medical care or surgery. Long-term tunneled catheters have cuffs that promote tissue ingrowth and are meant to stay in place for weeks or months during cancer treatment or parenteral nutrition. Implanted ports sit fully under the skin and are accessed percutaneously with a special needle.

Growing Usage of Central Lines in the U.S.
Data from the Healthcare Cost and Utilization Project shows substantial increases in central line placement rates over the past decade in the U.S. In 2011, there were an estimated 5 million central venous catheter days among inpatients, marking a 29% rise compared to 2006. Several factors likely contributed to this growth:

- Increased use of chemotherapy and total parenteral nutrition that require prolonged or high flow vascular access.

- Shorter hospital stays necessitating continuation of complex therapies as outpatients.

- Aging population with multiple chronic conditions.

- Advances in catheter technology making long-term use safer and more convenient.

Central lines are now routinely placed not just in intensive care units but also general medical-surgical floors and ambulatory clinics. Virtually all patients receiving chemotherapy or total parenteral nutrition long-term rely on a central venous access device.

Risks of Central Line-Associated Infections
While life-extending in many cases, central venous catheters are not without risks. One of the most serious dangers is central line-associated bloodstream infections (CLABSIs), which occur in an estimated 250,000 patients per year in the U.S. according to CDC statistics. These infections prolong hospital stays by an average of 7-10 days and increase mortality risk two- to four-fold.

CLABSIs develop when microbes gain access to the bloodstream through the insertion site, catheter hub or catheter itself. Common culprit pathogens include coagulase-negative Staphylococcus, Staphylococcus aureus, Candida species and Enterococci. Risk factors for infection include prolonged catheterization over 10-14 days, frequent hub manipulations or breaks in sterile technique. Premature catheter removal, particularly related to infection, defeats the original goals of extended venous access.

Safety Improvement Efforts
Given the human and economic toll of CLABSIs, there have been intensive efforts to reduce infection rates through multi-disciplinary protocols and monitoring. The CDC launched the On the CUSP: Stop CAUTI Project in 2010 focused on central line and urinary catheter safety practices in select hospitals across the U.S. Key evidence-based prevention strategies included:

- Maximal sterile barrier precautions and appropriate skin antisepsis during insertion

- Chlorhexidine for skin antisepsis rather than povidone-iodine

- Securement device to stabilize catheters and reduce manipulation

- Daily review of line necessity with prompt removal of unnecessary lines

- Antimicrobial impregnated catheters for select patient populations

Results showed nearly 300 hospitals collectively saw over a 50% reduction in CLABSI rates on average during the initiative which applied rigorous data tracking. Similar progress continued in numerous subsequent CDC prevention collaboratives. Some states have also enacted legislation mandating public reporting of hospital infection metrics.

With appropriate precautions, infection rates for central venous catheters have steadily dropped across the nation in recent years. Still, the devices will likely remain both lifesaving and potentially hazardous as healthcare treatment becomes more complex. Further research aims to extend catheter dwell times safely and develop novel materials less susceptible to microbial adhesion and biofilm formation. Strict adherence to evidence-based protocols during insertion and maintenance represents the best ongoing strategy to balance the risks versus benefits of these indispensable medical tools.

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