ABSTRACT

The use of intravascular devices for administration of chemotherapeutic drugs, fluids, blood products and nutritional support is essential to the care of patients with cancer. Unfortunately, intravascular devices have great potential to produce iatrogenic disease, especially bloodstream infection originating from colonization of the device used for access or from contamination of the infusate administered through the device. Over two-thirds of all healthcare-associated bacteremias originate from devices for vascular access. Probably more than any other healthcare-associated infection, IVDR BSI  is eminently preventable. The first step to preserve vascular access is a highly effective institutional program for prevention of IVDR BSI. In recent years, high-quality research studies have delineated key measures for prevention, such as chlorhexidine for cutaneous antisepsis, maximal barrier precautions, antiinfective-impregnated catheters, and the use of a CVC insertion “bundle” , and IVDR BSI rates in the ICU have declined markedly in most  hospitals. However, despite adherence to best practices, IVDR BSI continues to pose formidable challenges, especially in patients with cancer. Catheter salvage in the context of established IVDR BSI is particularly challenging but recent advances such as antibiotic lock technique are now providing previously unavailable options.