Invasive devices such as intravenous lines (IVs) and urinary catheters are necessary tools to help treat people who are ill. They are commonplace in most healthcare facilities and are even used at home. They are also often taken for granted by the people who use them. Unfortunately, whenever an invasive device is used, there is a potential for infection, including healthcare-acquired infections (HAIs), which can lead to sepsis.
Sometimes incorrectly called blood poisoning, sepsis is the body’s often deadly response to infection. Sepsis kills and disables millions and requires early suspicion and treatment for survival.
Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.
What is an invasive device?
An invasive device is any medical device that is introduced into the body, either through a break in the skin or through an opening in the body. Examples of common invasive devices include:
- Urinary catheters: Urinary catheters are rubber or silicone tubes inserted through your urethra to your bladder. A small balloon at the tip of the catheter is inflated once the catheter is in your bladder to keep the catheter from sliding back out. Your urine drains through the catheter into a bag attached to the other end. Occasionally, a doctor may order a one-time catheterization. For this procedure, the catheter is inserted only long enough to allow the urine to flow from the bladder and is then removed. This one time catheter use is less likely to cause an infection but is more inconvenient for patients if their doctors need to make sure that all the urine has been collected and measured.
- Intravenous lines: IVs are used to provide fluids, medications, and blood products directly into your blood stream. A small narrow catheter (hollow tube) is inserted into a vein, most often in your hand or lower arm. This catheter is attached to plastic tubing, which in turn is attached to a bag of fluid. In some cases, the catheter isn’t attached to tubing right away but has a cap instead to close it off. If you need IV fluid or medication later, the cap is removed and the tubing is attached.
- PICC lines: Similar to an IV, a PICC line is a special catheter inserted into a vein in your upper arm that stays in place for a longer period of time than a regular IV. A PICC line is very long and reaches nearly to your heart, to veins that are called central veins. A PICC line allows you to receive medications, such as an extended course of antibiotics or chemotherapy without having to restart IVs throughout the treatment. Patients can sometimes go home with a PICC line in place to continue their treatment at home. The line is removed when the antibiotics or other medicines are finished. A PICC line can also allow ICU patients to receive drugs that help keep their blood pressure stable.
- Central lines: Central lines or central venous catheters are similar to PICC lines but are usually inserted into a large vein in the chest or neck. They also stay in place for longer periods. These lines are also long enough to reach to the central veins. They can do the same things as a PICC line while a patient is in the hospital, but they can’t be left in when a patient goes home. Central lines are the IV catheters most likely to become infected, so doctors only use them when they are clearly necessary.
- Endotracheal tubes: An endotracheal tube is a semi-rigid tube inserted into your trachea (windpipe), most often through the mouth. The tube is attached to a ventilator, which is a machine that helps you breathe. In an emergency situation, an endotracheal tube may be inserted and attached to an Ambu bag, which allows medical personnel to manually push air into your lungs until you’re connected to a ventilator. If someone needs to be on a ventilator for an extended period, a surgeon may perfume a tracheotomy. This forms an opening in the throat for the endotracheal tube.
- Nephrostomy tubes: A nephrostomy tube is a narrow flexible catheter inserted directly into your kidney through an incision in your skin. It’s attached to a bag which collects urine.
- Gastrostomy tubes: A gastrostomy tube is a large catheter that provides liquid food and medications directly into your stomach. The tube is inserted through an incision in your abdomen and is hooked up to a special bag or a syringe.
- Traction pins: Traction pins are inserted through the skin into bone to stabilize the bone as it heals. Usually, these pins are used for accidental breaks in bones.
- Defibrillators: Inserted in the chest and wired to the heart to ensure the heart beats effectively at the appropriate rate.
- Joint implants: Knees, hips and other joints can be implanted to replace diseased or injured joints.
There are many more devices. These are just a few examples.
How can invasive devices cause infections?
Invasive devices themselves don’t cause infections, but they can provide a route for bacteria and fungi to enter the body. This can happen in different ways.
When a medical device is inserted, it’s important that the healthcare providers maintain a sterile field. The equipment they use must be sterilized before it is inserted into the body and sterility must be maintained during the insertion procedure. If the device is contaminated or becomes contaminated during the procedure, there is the risk of infection.
After a device is inserted, the site or area must be kept as clean as possible. There is now an unnatural opening into the body that can allow bacteria and fungi to enter. Here are a few examples of how to reduce the risk of infection with some invasive medical devices.
Most facilities have guidelines regarding how frequently IV lines and IV sites (where the catheter enters the skin) should be changed. The Centers of Disease Control and Prevention (CDC) recommends that IV tubing be changed every three to seven days, unless the patient is receiving blood products or fat emulsions. The tubing for these products must be changed within 24 hours. Certain types of medications given by IV also require more frequent changes. While it can be painful to have an IV inserted, the catheter (“needle”) should be removed and the IV restarted in another area every 72 to 96 hours.
Signs of an infected IV site include redness around the catheter insertion site, pain, and skin that is warm to the touch.
PICC lines and central lines are not replaced at the same rate as IVs. They are inserted with special care that includes surgical masks, gowns, and sterile gloves, which allows them to remain in place for longer, as long as they do not look infected.
People with urinary catheters are at risk for developing urinary tract infections (UTIs). The catheter provides an opening into the bladder for bacteria to enter. Urinary catheters should never be left open to air and should be attached to a closed-bag system. The bags should always be lower than your body to allow for urine flow and to prevent backward flow, but they should not be on the floor, as bacteria may collect on the bag and then enter the system. The bag should be emptied at least every 8 hours or when it is full, whichever comes first. It is also important that good hygiene be given to the genital area on a regular basis.
Urinary catheters are inserted for a variety of reasons, but are not usually meant to be left in for long periods of time. A person may have a catheter after having surgery or if he or she isn’t urinating. Occasionally, urinary catheters are left in longer than they should be. If you have a urinary catheter, you can ask your healthcare provider each day if you still need the catheter and if it can be removed.
Signs of a UTI include cloudy and/or foul smelling urine, pain on urination and fever. Seniors may develop confusion and not show any of the typical signs.
Traction pins go directly into the bone, so infections could delay bone healing if they developed in the bone itself. Pins should be cleaned regularly as per your healthcare provider’s instructions, usually twice a day.
Signs of an infection in the pin area include redness and warmth around the area, swelling, increasing pain at the site, drainage or pus from the site, and fever.
If you have any invasive devices, watch for any signs and symptoms of infection and sepsis.
If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.”
The information here is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.
Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.
Updated September 18, 2020.