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HMS Critical Care Vascular Access Toolkit

In critical care, evidence-based vascular access guidelines, decision support tools, and structured communication protocols reduce complications, enhance patient safety, and support consistent, high-quality, and cost-effective care.

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Reduce Complications in Vascular Access in the Critically Ill Patient Population

Background, Rationale and Suggested Implementation Strategies
  • Complications from vascular access device use can significantly impact patient outcomes. Focusing on reducing these complications directly improves patient safety and quality of care.
  • Complications often lead to increased healthcare costs due to prolonged hospital stays, additional treatments, and interventions. Reducing complications can lead to significant cost savings.
  • Utilizing evidence-based strategies and guidelines helps in standardizing care, reducing variability in practice, and ultimately improving outcomes.
  • Educating staff on best practices can not only reduce complications but also reduce staff workload related to managing complications, allowing for more focus on proactive care measures.
  • Establish evidence-based protocols for the insertion, maintenance, and removal of vascular access devices. Ensure guidelines align with national and international standards and best practices.
  • Involve a multidisciplinary team, including infection control specialists, to oversee vascular access practices and provide regular feedback on performance and outcomes.
  • Ensure thorough patient assessments to guide the selection of the most appropriate vascular access devices, considering factors such as the intended duration of use and patient-specific risks.
Resources and Tools
References
  • Timsit, J. et al. A State of the Art Review on Optimal Practices to Prevent, Recognize, and Manage Complications Associated with Intravascular Devices in the Critically Ill. Intensive Care Medicine 2018.
    • Review offers current insights into the epidemiology, diagnosis, and optimal treatment of complications such as infections and thrombosis related to central vein and arterial catheters in the ICU. It highlights that preventing these complications requires a multidisciplinary approach, combining care process improvements and new technologies, while also identifying key prevention strategies and suggesting areas for future research.
  • Alonso-Echanove J. et al. Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units. Inf Cont & Hosp Epi 2015.
    • Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.
  • Bernholtz, S.M. et al. Eliminating catheter-related bloodstream infections in the intensive care unit. CCM 2004.
    • The study aimed to eliminate CRBSIs by implementing a multifaceted intervention that included staff education, a catheter insertion cart, daily catheter necessity assessments, a compliance checklist, and empowering nurses to halt insertions if guidelines were violated. These interventions resulted in a near-elimination of CRBSIs in the surgical ICU by ensuring adherence to evidence-based infection control practices.
  • Toor H. Prevalence of Central Line-Associated Bloodstream Infections (CLABSI) in Intensive Care and Medical -Surgical Units. Cureus 2022.
    • The study reviewed 1,125 CVC insertions at a healthcare institution and found specific practices that contributed to CLABSIs, such as prolonged catheter use. To reduce CLABSI rates, recommendations include strict adherence to central line insertion practice documentation for all CVCs and timely catheter changes for patients exhibiting abnormal white blood cell counts or temperatures and those with certain CVC types or prolonged use.
  • Nolan, M. et al. Complication Rates Among Peripherally Inserted Central Venous Catheters and Centrally Inserted Central Catheters in the Medical Intensive Care Unit. Journal of Critical Care 2016.
    • The study, conducted in a medical ICU, evaluated complication rates of PICCs and CVCs in 400 cases, finding that both thrombotic and infectious complications were uncommon with no significant difference between the two catheter types. Notably, half of the PICC related DVTs occurred after transfer to the general floor, indicating that PICCs, like all central catheters, should be promptly removed when no longer necessary to minimize risks.
  • Pronovost, P. et al. An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU. New England Journal of Medicine 2006.
    • The collaborative cohort study conducted in Michigan ICUs implemented an evidence-based intervention that significantly reduced catheter-related bloodstream infections, with infection rates dropping from a median of 2.7 per 1,000 catheter-days at baseline to 0 within three months and a sustained decrease to 1.4 infections at 16 to 18 months. The intervention demonstrated a substantial and lasting impact, reducing infection rates by up to 66% over the 18-month study period.
  • Ullman, A. et al. A Comparison of Peripherally Inserted Central Catheter Materials. New England Journal of Medicine 2025.
    • In a randomized trial involving 1,098 participants across three Australian hospitals, PICCs made of hydrophobic and chlorhexidine materials did not show a lower risk of device failure from infectious or noninfectious complications compared to standard polyurethane PICCs. Throughout the 8-week follow-up, device failure rates were similar across groups, and no adverse events were linked to the catheter materials, indicating that the newer materials did not provide superior outcomes.