Prevention of Peripheral Venous Catheters Related Infections

1. Selection of peripheral catheter 
A. Select catheters on the basis of the intended purpose and duration of use, known complications (e.g., phlebitis and infiltration), and experience of individual catheter operators.

B. Avoid the use of steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs.

C. Use a midline catheter or PICC when the duration of IV therapy will likely exceed 6 days.

2. Selection of peripheral-catheter insertion site
A. In adults, use an upper- instead of a lower-extremity site for catheter insertion. Replace a catheter inserted in a lower-extremity site to an upper-extremity site as soon as possible.

B. In pediatric patients, the hand, the dorsum of the foot, or the scalp can be used as the catheter insertion site.

3. Insertion site preparation 
Use of antiseptic solution for skin disinfection at the catheter insertion site helps prevent catheter-related infection. Chlorhexidine-based solutions appear to be superior to both aqueous and alcohol-based povidone-iodine in reducing the risk for catheter colonization and catheter-related bloodstream infection

4. Replacement of catheter 
A. Evaluate the catheter insertion site daily, by palpation through the dressing to discern tenderness and by inspection if a transparent dressing is in use. Gauze and opaque dressings should not be removed if the patient has no clinical signs infection. If the patient has local tenderness or other signs of possible catheter related blood stream infection (CRBSI), an opaque dressing should be removed and the site inspected visually. 

B. Remove peripheral venous catheters if the patient develops

• signs of phlebitis (e.g., warmth, tenderness, erythema, and palpable venous cord),
• infection, or
• a malfunctioning catheter.

C. In adults, replace short, peripheral venous catheters at least 72–96 hours to reduce the risk for phlebitis. If sites for venous access are limited and no evidence of phlebitis or infection is present, peripheral venous catheters can be left in place for longer periods, although the patient and the insertion sites should be closely monitored.

D. Do not routinely replace midline catheters to reduce the risk for infection.

E. In pediatric patients, leave peripheral venous catheters in place until IV therapy is completed, unless a complication (e.g., phlebitis and infiltration) occurs

5. Replacement of catheter-site dressing
Replace dressing when the catheter is removed or replaced, or when the dressing becomes damp, loosened, or soiled. There is no need to remove a gauze or opaque dressing if the patient has no clinical signs of infection.

6. Catheter and catheter-site care 
Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment or cream to the insertion site of peripheral venous catheters.

(Prevention Guidelines for Catheter-Related Infections • CID 2002)