Prevention of arterial catheter-related bloodstream infections: current evidence and future directions

Arterial catheters (ACs) are essential devices widely used for hemodynamic monitoring and blood sampling. Whilst their infectious risk is well-known, the surveillance and identification of arterial catheter-related bloodstream infections (AC-CRBSI) remains underappreciated, and guidelines recommending best practices to prevent infection are few and inconsistent. Most evidence for AC infection prevention is inferred from studies focused on central venous catheter infection prevention. Few studies have directly explored optimal infection prevention strategies for ACs. For AC-CRBSI prevention, several strategies are valuable during insertion and maintenance of the catheter: minimisation of catheter-days by appropriate catheter stewardship, procedural training of providers, standardisation of insertion packs to promote adherence to an insertion bundle, cutaneous antisepsis with an alcohol-based 2% chlorhexidine solution during insertion and maintenance, chlorhexidine impregnated dressings, change of dressing every 7 days unless visibly disrupted or soiled, hand hygiene, disinfection of the access port and change of administration sets every 7 days. Other interventions to prevent AC-CRBSI are more controversial and necessitate further research such as the choice of the insertion site (femoral vs. radial), the type of sterile barrier precautions and their cost effectiveness, the infectious risk related to ultrasound guidance, the optimal catheter securement device, the utility of needleless connectors and closed loop blood sampling systems and the effectiveness of scheduled catheter changes. Arterial catheters demonstrate an ongoing risk of contamination throughout their lifespan, from insertion to removal. A comprehensive prevention strategy should address the entire arterial catheter lifecycle and is most effective when implemented as a bundled approach. This review summarises current knowledge on AC-CRBSI prevention during the entire lifecycle of the catheter and identifies priorities for future research.