1. Introduction:
   • Intravascular catheters are essential for critically ill patients
   • Catheter-related bloodstream infections (CR-BSIs) are a significant concern in ICU patients
2. Pathophysiology and microbiology:
   • Catheter colonization can occur via the extraluminal or intraluminal route
   • Different diagnostic options and preventive strategies depend on the type of catheter
3. Definitions:
   • Definitions of BSIs caused by vascular catheters are important to interpret clinical evidence
   • CLA-BSI and CR-BSI are the two major definitions
4. Diagnosis of catheter infections:
   • Clinical signs at catheter removal are predictive for catheter infection
   • Quantitative culture techniques can help diagnose catheter-related infections
5. Diagnosis of CR-BSI with catheter in place:
   • Prompt removal of catheter is necessary in severe sepsis or shock
   • Diagnostic techniques that allow accurate diagnosis while keeping the catheter in place are beneficial
6. Quantitative culture of the catheter exit site:
   • Negative culture of the catheter exit site may rule out CR-BSI or colonization
   • Skin and flushed needleless connectors culture can be an alternative option
7. Differential time to positivity:
   • Differential time to positivity of blood cultures can help diagnose CR-BSI
   • It has been proposed as a means to diagnose CR-BSI
8. Conclusion:
   • Healthcare worker education and training are crucial in preventing catheter-related infections
   • New technical developments should be considered according to available recommendations
9. Sampling of lumens in triple-lumen catheters for CR-BSI diagnosis:
   • One out of three lumens of triple-lumen catheters misses 37% of the CR-BSI cases.
   • Role of DTP for the diagnosis of specific microorganism CR-BSIs remains debated.
10. Diagnosis of Candida CR-BSI with DTP:
    • Retrospective study showed good sensitivity (85%) and specificity (82%).
    • Other investigators reported a specificity of only 40%.
11. Diagnosis of S. aureus, CoNS, or non-AmpC Enterobacteriaceae CR-BSI with DTP:
    • Controversies exist for the diagnosis of these types of CR-BSI with DTP.
12. Diagnosis of CR-BSI using paired quantitative blood cultures:
    • Microorganism colony count is higher in blood cultures obtained from CVC versus peripheral blood.
    • Lack of standardized cutoff points and limited use of quantitative blood cultures.
13. Prevention of CR-BSI:
    • Avoid unnecessary intravascular catheters to prevent CR-BSI.
    • Peripheral intravenous lines can be used for low-dose vasoactive medication.
    • Assess the need for CVCs daily and remove unnecessary CVCs.
    • Updated guidelines on CR-BSI prevention are available.
14. Catheter insertion and prevention of CR-BSI:
    • Full sterile barrier precautions during catheter insertion are essential.
    • Skin antisepsis is important; use a sterile 2% chlorhexidine gluconate (CHG) solution.
    • Consider using applicators or sterile gauze for antiseptic application.
    • Sequential use of PVI-containing and CHG cutaneous antiseptics may be beneficial.
    • Chlorhexidine patient bathing may reduce CLA-BSI, but caution is needed.
    • Selection of the insertion site should consider the benefits and risks.
    • Subclavian site is preferred to reduce infectious complications.
15. Catheter fixation and ultrasound-guided placement:
    • Suture-free securement system for catheter fixation.
    • Ultrasound-guided placement improves procedural success and reduces mechanical complications.
16. Ultrasound guidance for catheter insertion:
    • Ultrasound guidance may help reduce complications like pneumothorax
    • Its impact on catheter infections is uncertain, with conflicting studies
17. Thrombosis and infection:
    • Catheter thrombosis may increase the risk of infection
    • The use of heparin in preventing catheter-related bloodstream infections (CR-BSI) remains controversial
18. Heparin-bonded catheters:
    • Limited data on heparin-bonded catheters in ICU adults
    • Mixed findings on their effectiveness in reducing catheter-related thrombosis and infections
19. Catheter care: Replacement:
    • Repeated catheterizations increase the risk of infection
    • Routine replacement of functioning catheters has not shown to lower infection rates
20. Catheter care: Dressing:
    • Transparent dressings allow continuous observation and reduce colonization
    • Optimal frequency of dressing changes not well-established