Central Venous Access: Prevention of Infectious Complications

From Cardiac Anesthesiologist blog

• • For immunocompromised patients and high-risk neonates, administer intravenous antibiotic prophylaxis on a case-by-case basis.
  • Intravenous antibiotic prophylaxis should not be administered routinely.

  • In preparation for the placement of central venous catheters, use aseptic techniques (e.g.  , hand washing) and maximal barrier precautions (e.g.  , sterile gowns, sterile gloves, caps, masks covering both mouth and nose, and full-body patient drapes).
  • A chlorhexidine-containing solution should be used for skin preparation in adults, infants, and children.
    • For neonates, the use of a chlorhexidine-containing solution for skin preparation should be based on clinical judgment and institutional protocol.
    • If there is a contraindication to chlorhexidine, povidone-iodine or alcohol may be used as alternatives.
    • Unless contraindicated, skin preparation solutions should contain alcohol.

• • If there is a contraindication to chlorhexidine, povidone-iodine or alcohol may be used. Unless contraindicated, skin preparation solutions should contain alcohol.
  • Catheters coated with antibiotics or a combination of chlorhexidine and silver sulfadiazine should be used for selected patients based on infectious risk, cost, and anticipated duration of catheter use.
    • Catheters containing antimicrobial agents are not a substitute for additional infection precautions.
  • Catheter insertion site selection should be based on clinical need.
    • An insertion site should be selected that is not contaminated or potentially contaminated (e.g.  , burned or infected skin, inguinal area, adjacent to tracheostomy or open surgical wound).
    • In adults, selection of an upper body insertion site should be considered to minimize the risk of infection.
  • The use of sutures, staples, or tape for catheter fixation should be determined on a local or institutional basis.
  • Transparent bio-occlusive dressings should be used to protect the site of central venous catheter insertion from infection.
    • Unless contraindicated, dressings containing chlorhexidine may be used in adults, infants, and children.
    • For neonates, the use of transparent or sponge dressings containing chlorhexidine should be based on clinical judgment and institutional protocol
    • The duration of catheterization should be based on clinical need.
    • • The clinical need for keeping the catheter in place should be assessed daily.
      • Catheters should be removed promptly when no longer deemed clinically necessary.

• The catheter insertion site should be inspected daily for signs of infection.
  • The catheter should be changed or removed when catheter insertion site infection is suspected.
• When a catheter-related infection is suspected, replacing the catheter using a new insertion site is preferable to changing the catheter over a guidewire.
• Catheter access ports should be wiped with an appropriate antiseptic before each access when using an existing central venous catheter for injection or aspiration.
• Central venous catheter stopcocks or access ports should be capped when not in use.
• Needleless catheter access ports may be used on a case-by-case basis.