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.