Removal versus retention of vascular access devices (VADs) suspected of infection in the intensive care unit (ICU): a narrative review of the literature

Background: Whether to remove or retain vascular access devices (VADs) when they are suspected of infection is an important clinical question with no certain answer. This review aims to explore current literature related to removal versus retention of central venous catheters (CVCs) and intra-arterial lines (IALs) suspected of infection in the adult intensive care population. Methods: A narrative review of studies describing management of VADs suspected of infection in the intensive care unit (ICU) was undertaken. After a systematic search, two clinical studies were included in the review. The methodological rigour of these studies was assessed per the Mixed Methods Appraisal Tool (MMAT). Results: The two eligible studies consisted of one randomised control trial and one prospective observational study, including a total of 448 patients. Both studies scored highly on the MMAT, but only pertained to CVCs. No studies relating to other VAD types were identified. No significant differences in outcome were identified between patients whose VADs were removed or retained in the adult ICU cohort, apart from a reduction in number of CVC replacements in patients whose VAD was retained after infection was suspected. Conclusions: There is minimal evidence pertaining to removal versus retention of VADs suspected of infection in the adult ICU patient cohort, and there are limited recommendations specific to suspected infection guiding clinical practice. As a result, VADs may be unnecessarily removed. Further research assessing these important patient outcomes are urgently needed to inform clinical practice.