The PICC Lines Plus design is a trademark of PICC Lines Plus. No comparison has been made between using chlorhexidine preparations with alcohol and povidone-iodine in alcohol to prepare clean skin. No recommendation can be made for the safety or efficacy of chlorhexidine in infants aged <2 months.
In pediatric patients, the upper or lower extremities or the scalp (in neonates or young infants) can be used as the catheter insertion site. Do not use guidewire exchanges routinely for non-tunneled catheters to prevent infection. Avoid the subclavian site in hemodialysis patients and patients with advanced kidney disease, to avoid subclavian vein stenosis. Maintain aseptic technique for the insertion and care of intravascular catheters. Midline Catheters: The midline catheter (i.e. Use a sterile sleeve for all pulmonary artery catheters.
Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter.
When the pressure monitoring system is accessed through a diaphragm, rather than a stopcock, scrub the diaphragm with an appropriate antiseptic before accessing the system. Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR). Keep all components of the pressure monitoring system (including calibration devices and flush solution) sterile. Catheters Used for Venous and Arterial Access, Epidemiology and Microbiology in Adult and Pediatric Patients, Strategies for Prevention of Catheter-Related Infections in Adult and Pediatric Patients, U.S. Department of Health & Human Services.
Promptly remove any intravascular catheter that is no longer essential.
Use a CVC with the minimum number of ports or lumens essential for the management of the patient. In adults, use an upper-extremity site for catheter insertion. A minimum of a cap, mask, sterile gloves and a small sterile fenestrated drape should be used during peripheral arterial catheter insertion. Minimize the number of manipulations of and entries into the pressure monitoring system. therapy: The recommended insertion site is the basilic, cephalic, or median vein in the antecubital fossa. Sterile gloves should be worn for the insertion of arterial, central, and midline catheters. If the patient is diaphoretic or if the site is bleeding or oozing, use a gauze dressing until this is resolved. Cleanse the umbilical insertion site with an antiseptic before catheter insertion. Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Evaluate the catheter insertion site daily by palpation through the dressing to discern tenderness and by inspection if a transparent dressing is in use. To receive email updates about this page, enter your email address: Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011), Centers for Disease Control and Prevention.
Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and accessing the port only with sterile devices. Only clinicians certified in midline placement may place a midline catheter. Use a chlorhexidine/silver sulfadiazine or minocycline/rifampin -impregnated CVC in patients whose catheter is expected to remain in place >5 days if, after successful implementation of a comprehensive strategy to reduce rates of CLABSI, the CLABSI rate is not decreasing. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale. Do not submerge the catheter or catheter site in water. Avoid the use of steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs. When adherence to aseptic technique cannot be ensured (i.e., catheters inserted during a medical emergency), replace the catheter as soon as possible, i.e., within 48 hours. You will be subject to the destination website's privacy policy when you follow the link. During axillary or femoral artery catheter insertion, maximal sterile barriers precautions should be used. Educate healthcare personnel regarding the indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters, and appropriate infection control measures to prevent intravascular catheter-related infections. Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, or alcoholic chlorhexidine gluconate solution) before peripheral venous catheter insertion.
Use either sterile gauze or sterile, transparent, semipermeable dressing to cover the catheter site. Observational studies suggest that a higher proportion of “pool nurses” or an elevated patient–to-nurse ratio is associated with CRBSI in ICUs where nurses are managing patients with CVCs.
Do not routinely use anticoagulant therapy to reduce the risk of catheter-related infection in general patient populations. No recommendation can be made regarding the use of a designated lumen for parenteral nutrition.
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