Outline  strategies  you  would  incorporate  to  prevent  central  venous  catheter  related infection.

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College Answer

A number of different strategies should be considered. One approach to incorporate these follows:

Why? Confirm need for Central Venous Line (initial, and ongoing).

How? Pay attention to sterile insertion technique. Non occlusive dressing, transparent semipermeable dressing or dressing with topical disinfectant.

What? Use single lumen where possible; consider antibiotic impregnated line.

Where? Subclavian site preferentially over Internal Jugular or femoral; consider PICC lines

(peripherally inserted central catheters),

When remove? Daily site inspections, and consider early change.

Replace giving sets/lines regularly: blood and TPN giving sets 24hrly but other IV sets after 72 hrs

Twenty-two out of twenty-six candidates passed this question.

Discussion

This is one of those topics an intensivist is expected to be the master of. It is no wonder that the majority of candidates received a passing grade for their answers.

A recent SHEA/ADSA guidelines document (2014) is available for leasurely perusal. It, however, is too massive and fibrous to digest in a short span of time.

However, our very own ANZICS statement on insertion and maintenance of CVCs is a more concise and more manageable document. The following list of points is derived from this document.

This is a point-form synopsis of CVC features and practices associated with a decreased risk of CVC infection:

  • Intelligence use of CVCs (i.e. does the patient even need one?)
  • Subclavian lines.
  • Minimum number of lumens.
  • Use of dedicated lumens for lipid infusions.
  • Immunosuppressed patients or those with burns should have antibiotic-coated lines.
  • For insertion, use aseptic technique and maximal barrier precautions.
  • 0.5% chlorhexidine in 70% alcohol is the preferred cleaning agent.
  • Handle ends of administration sets with gauze soaked in chlorhexidine).
  • Review the line daily.
  • Remove the line as soon as possible.
  • Change lines early - ideally, every 7 days.
  • Sterile, transparent semipermeable dressings
  • Change dressings regularly (every 7 days for standard dressings)

References