Current estimates suggest that in the UK, around 500,000 people are immunocompromised. This number equates to 0.7% of the population [1] who are higher risk for severe outcomes should an infection occur.
It is well known that incidences of CLABSIs (Central line associated bloodstream infections) have a significant impact to the patient, their treatment, and associated costs. This could be even more damaging should the patient have a pre-existing immunosuppression condition and/or are considered a high-risk patient.
Therefore, for these patient populations, additional considerations and precautions can be taken to reduce the risks of CLABSI and are a crucial consideration during vascular access and mid- to long-term IV therapies.
For this patient group, we present four key considerations for vascular access for immunosuppressed or high-risk patients:
- Antimicrobial lines
- Device selection: valved lines and/or valved needle free connectors
- Line securement
- Aseptic technique and best practices for care and maintenance of vascular access devices.
Immunosuppressed / Immunocompromised patients:
Examples of immunosuppressed and immunocompromised patients include, but are not limited to:
- Patients with genetic conditions affecting immune function
- Patients with autoimmune diseases such as Type 1 diabetes, Lupus, Multiple Sclerosis and Inflammatory Bowel Disease.
- Patients with an existing disease or viruses, such as HIV
- Patients with chronic illnesses such as Sickle Cell Disease
- Patients undergoing radical radiotherapy or immunosuppressive chemotherapy
- Patients taking other immunosuppressant drugs, therapies, or treatments (such as transplant recipients)
- High-risk patients under intensive or critical care.
Antimicrobial PICC Lines
An initial consideration to improve care and reduce infection risk for the immunocompromised or suppressed patient is of which choice of line is placed for their vascular access and treatment administration.
For example, clinicians could consider using an antimicrobial PICC that has embedded antibiotics or silver ions.
Impregnation options you may see include:
- Chlorhexidine
- Minocycline
- Rifampicin
- Or Silver Ions (Agion antimicrobial technology)*
*Agion – compound of inorganic silver ions which maintains an antimicrobial surface to help control infection.
“Testing a range of medical-grade polymers, Sciessent found that those treated with Agion® antimicrobial technology killed more than 99 percent of antibiotic-resistant pathogens. In the case of multiple types of central-venous catheters, MRSA was reduced between 99.56 percent and 99.999 percent and CRE was eliminated by 99.9999 percent or more – with no viable bacteria detected 24 hours after inoculation for most catheter types.” [2] Megan Coyle, Wakefield, MA (PRWEB) May 04, 2015
For more information on an Agion antimicrobial impregnated PICC see the Maxflo Expert PICC.
Valved Lines and/or Needle-Free Connectors
Vascular access device selection is also a key consideration for vascular access and therapies in immunosuppressed patients, to support better outcomes.
By identifying and adopting best practice in vascular access device selections can reduce risks of occlusions and therefore a reduction in potential subsequent negative patient outcomes.
Device choice considerations:
- Choosing a valved or non-valved line: Available on the market are vascular access lines either with or without integrated valves.
- Choice of needle-free connectors: Alternatively, clinicians may choose a non-valved vascular access line (potentially one with antimicrobial properties) but then choosing to use a valved needle-free connector.
Having the valve either within the line and/or within the needle-free connector helps to prevent reflux and are proven to be effective in lowering rates of occlusions. Reducing occlusions subsequently reduces associated infections, complications and other associated negative consequences.
Impact of occlusions include:
- Interrupted therapy / treatment
- Increased hospital stay / visits
- Catheter-related bloodstream infections
- Phlebitis
- Extravasation
- Associated cost to hospitals from the above conditions
Line Securement
Choice of line securement is also a factor when considering achieving best patient outcomes in mid- to long-term vascular access. As the line securement is crucial to preventing catheter movement, dislodgement, and subsequent infection potential.
Current standard practices include the use of sutures or adhesives both of which can be challenged with potential complications. Therefore, for high-risk patients, or those existing immunocompromising conditions, a superior option for line securement is recommended to further reduce infection risks.
Clinicians should therefore consider a line securement solution with reduced infection risks. For this, subcutaneous anchor securement systems are gaining in popularity for securing PICCs lines, midlines and CVCs.
Studies have shown a 288% decreased risk of CLABSI with the SecurAcath device, compared to adhesive devices.[3]
For more information see SecurAcath
Aseptic technique and clinical best practice for care and maintenance of vascular access lines
Although the vascular access device may be ‘top of range’ in infection prevention capabilities, clinicians and healthcare professionals must not forget the key principles and practices of Aseptic techniques and within the care and maintenance of vascular access sites and lines to help reduce infection risks.
The importance of patient education and vascular access: this guidance is not only important for clinicians and healthcare professionals treating the patient, but also as an educational area for the patient themselves.
As mid- to long-term IV therapies may require the device to remain in-situ for an extended period and even be present in an at-home or non-clinical settings. Therefore, patients must be educated on proper care and maintenance of their vascular access device to help prevent damage, reduce infection risk, and known the signs of complications should they arise.
Conclusions
Clinical Choices and Cost Considerations
Clinicians and hospitals may find when researching these options, such as antimicrobial lines and valved needle-free connectors, that there is a higher initial cost per catheter.
However, one should also consider that the effectiveness in reducing CRBSI/CLABSIs and associated costs, and along with better patient outcomes. The results often support their use for long-term IV therapies in specific patient populations such as the immunosuppressed or high-risk patients and ultimately reducing the possibility of severe outcomes due to infection.
References
[1] https://www.bmj.com/content/376/bmj.o722
[2] Megan Coyle, Wakefield, MA (PRWEB) May 04, 2015 https://pmc.ncbi.nlm.nih.gov/articles/PMC3462094
[3] Rowe, M.S, Arnold, K, Spencer, T.R “Catheter securement impact on PICC-related CLABSI: A university hospital perspective” (2020) American Journal of Infection Control. Pg1497-1500.
