CENTRAL VENOUS CATHETER (CVC) MANAGEMENT

Complications associated with central venous catheters include infection, phlebitis, and catheter-related bloodstream infections (CR-BSI). These complications can be avoided following certain measures:

• Hand washing
• Choosing appropriate sites for catheter insertion
• Using the appropriate type of catheter material
• Full barrier precautions during insertion of CVCs
• Chlorhexidine for skin disinfection
• Avoidance of the femoral insertion site
• Changing catheter administration sets at appropriate intervals
• Ensuring proper catheter-site care
• Removal of catheters when no longer indicated

CVC SITE CARE

CHLORHEXIDINE BATHING — Daily chlorhexidine bathing for ICU patients may reduce MRSA and VRE colonization.

STERILE TECHNIQUE —This includes strict adherence to hand washing and aseptic technique, sterile gloves, long-sleeved surgical gown, a surgical mask, and a large sterile sheet drape.

INSERTION SITE PREPARATION —  Chlorhexidine-based solutions are superior to both aqueous and alcohol-based povidone-iodine in reducing the risk for catheter colonization and CR-BSI.

DRESSING — The type of dressing at the insertion site may affect the rate of catheter infection.

Transparent versus gauze — Most studies have demonstrated a higher rate of colonization and infection with transparent compared to gauze dressings for CVCs.

Chlorhexidine — Use of a chlorhexidin gluconate-impregnated sponge in intravenous catheter dressings may reduce catheter-related infections.

Topical antimicrobials — DO NOT use topical antimicrobial ointments for CVC related infections EXCEPT for CVCs used for haemodialysis in which topical antimicrobial ointments significantly reduce both catheter-related infection and bacteremia.