The Pathogenesis of CLABSIs

There are five chief sources of Central Line-Associated Bloodstream Infections (CLABSIs):

The Arrow® ErgoPack® System with Arrowg+ard® Protection catheters give you a comprehensive approach for helping to prevent each one.

Skin organisms

The bacterial burden can be reduced drastically by using antiseptics such as ChloraPrep (a >0.5% chlorhexidine preparation with alcohol is a CDC 1A recommendation for prepping insertion sites) or BIOPATCH® (use of a chlorhexidine-impregnated sponge dressing for temporary short-term catheters is a CDC 1B recommendation).1 In at least one study, a 2 percent chlorhexidine solution was superior to a 70 percent isopropyl alcohol solution and 10 percent Povidone-iodine for reducing the incidence of IV device-related infections.2 Teleflex's® Arrow® brand central line kits are the only products with Hi-Lite Orange® ChloraPrep.

Environmental contamination

According to the 2011 CDC guidelines, 250,000 Catheter-Related Bloodstream Infections occur in the U.S. each year.1 It is estimated that each incident of CVC-associated bloodstream infection can cost between $34,508-$56,000.3

At least two studies prove that maximal barrier precautions significantly reduce the likelihood of bloodstream infection.5,6 For example, Raad et al. found that the chance of infection was 6.3 times higher without maximal barrier precautions.

As important as using maximal barrier precautions are, as soon as the drape, gown, mask and cap are in the trash can, the catheter is open to contamination. In a prospective study of short-term, non-cuffed CVCs used in patients in an ICU, Safdar and Maki reported that 26 percent of CVC-related bloodstream infections appear to be derived from internal lumen contamination.7

Post-placement subcutaneous tract infection

Despite the use of barrier protection and surface antiseptics, bacteria can still gain access to the subcutaneous tract. Chlorhexidine-based technology impregnated into a catheter's surface “preps” the subcutaneous tract with antimicrobials at the time of insertion, then continues to have an inhibitory effect in the subcutaneous tract. Arrowg+ard Blue Plus® Catheters and Arrowg+ard Blue Advance Catheters feature chlorhexidine impregnated into both the exterior and interior catheter surfaces.

Intraluminal contamination

As many as 26 percent of central venous catheter related bloodstream infections appear to be derived from internal lumen contamination.7 This occurs through repeated access into the system and/or breaks in technique during which bacteria gain access to the internal lumens of the catheter. Antimicrobial catheters protected on their intraluminal surface have every lumen protected with chlorhexidine to significantly reduce colonization. Arrowg+ard Blue Plus® Catheters and Arrowg+ard Blue Advance Catheters are the only antimicrobial catheters that have catheter hub and extension line protection as well.

Hematogenous seeding

Hematogenous seeding occurs when bacteria attach to the catheter from a distant site. Antimicrobial catheters with Arrowg+ard® Protection and Arrowg+ard Blue Plus® Protection, have been shown effective at significantly reducing colonization of their surface.8,9


  1. O'grady, N.P., Alexander, M., Burns L.A., Dellinger, P., Garland, J., Heard, S.O., Lipsett P.A., Masur, H., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A, Rupp, M.E., Saint, S.. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. The Centers for Disease Control. Accessed May 16, 2011.
  2. Maki, D., Ringer, M., Alvarado, C.J. Prospective Randomized Trial of Povidone-iodine, Alcohol and Chlorhexidine for Prevention of Infection Associated With Central Venous and Arterial Catheters. Lancet. August 1991; Vol. 338: 339–343.
  3. O'Grady, N.P., Alexander, M., Dellinger, E.P., Gerberding, J.L., Heard, S.O., Maki, D.G., Masur, H., McCormick, R.D., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A., Weinstein, R.A. Guidelines for the Prevention of Intravascular Catheter-Related Infections. Centers for Disease Control. August 9, 2002; Vol. 51 (RR10): 7–8.
  4. Murphy, D., Whiting, J. Dispelling the Myths: The True Cost of Healthcare-Associated Infections. An APIC Briefing, February 2007.
  5. Raad, I.I., Hohn, D.C., Gilbreath, B.J., et al. Prevention of Central Venous Catheter-Related Infections by Using Maximal Sterile Barrier Precautions During Insertion. Infection Control Hospital Epidemiology. 1994; Vol. 15 (4 Pt 1): 231–238.
  6. Mermel, L.A., McCormick, R.D., Springman, S.R., Maki, D.G. The Pathogenesis and Epidemiology of Catheter-Related Infection With Pulmonary Artery Swan-Ganz Catheters: A Prospective Study Utilizing Molecular Subtyping.American Journal of Medicine. 1991; Vol. 91 (3B): 197S–205S.
  7. Safdar, N., Maki, D.G. The Pathogenesis of Catheter-Related Bloodstream Infection With Noncuffed Short-Term Central Venous Catheters. Intensive Care Medicine. January 2004; Vol. 30(1): 62–67.
  8. Maki, D.G., Stolz, S.M., Wheeler, S., Mermel, L.A. Prevention of Central Venous Catheter-Related Bloodstream Infection With an Antiseptic-Impregnated Catheter: A Randomized, Controlled Trial. Annals of Internal Medicine. August 15, 1997; Vol. 127(4): 257–266.
  9. Rupp, M.E., Lisco, S.J., Lipsett, P.A., Perl, T.M., Keating, K., Civetta, J.M., Mermel, L.A., Lee, D., Dellinger, P.E., Donahue, M., Giles, D., Pfaller, M.A., Maki, D.G., Sherertz, R. Effect of a Second-Generation Venous Catheter Impregnated With Chlorhexidine and Silver Sulfadiazine on Central Catheter-Related Infections: A Randomized, Controlled Trial. Annals of Internal Medicine, October 18, 2005; Vol. 143(8): 570–581.
BioPatch is a registered trademark of Johnson and Johnson. Hi-Lite Orange and ChloraPrep are trademarks of Care Fusion Inc. BIOPATCH® is a registered trademark of Johnson & Johnson Corporation. Rx only No correlation between in vitro / in vivo testing methods and clinical outcomes have currently been ascertained. Teleflex, the Teleflex logo, Arrow, Arrowg+ard, Arrowg+ard Blue Advance, Arrowg+ard Blue Plus, ErgoPack, and HemoHopper are trademarks or registered trademarks of Teleflex Incorporated or its affiliates, in the U.S. and/or other countries. All other trademarks are trademarks of their respective owners. MC-004519