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2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections

Download the complete 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections [PDF - 1.05 MB]

Patient Cleansing

Use a 2% chlorhexidine wash for daily skin cleansing to reduce CRBSI [102–104]. Category II

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Catheter Securement Devices

Use a sutureless securement device to reduce the risk of infection for intravascular catheters [105]. Category II

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Antimicrobial/Antiseptic Impregnated Catheters and Cuffs

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. The comprehensive strategy should include at least the following three components: educating persons who insert and maintain catheters, use of maximal sterile barrier precautions, and a >0.5% chlorhexidine preparation with alcohol for skin antisepsis during CVC insertion [106–113]. Category IA

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Systemic Antibiotic Prophylaxis

Do not administer systemic antimicrobial prophylaxis routinely before insertion or during use of an intravascular catheter to prevent catheter colonization or CRBSI [114]. Category IB

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Antibiotic/Antiseptic Ointments

Use povidone iodine antiseptic ointment or bacitracin/gramicidin/ polymyxin B ointment at the hemodialysis catheter exit site after catheter insertion and at the end of each dialysis session only if this ointment does not interact with the material of the hemodialysis catheter per manufacturer’s recommendation [59, 115–119]. Category IB

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Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush and Catheter Lock Prophylaxis

Use prophylactic antimicrobial lock solution in patients with long term catheters who have a history of multiple CRBSI despite optimal maximal adherence to aseptic technique [120– 138]. Category II

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Anticoagulants

Do not routinely use anticoagulant therapy to reduce the risk of catheter-related infection in general patient populations [139]. Category II

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Replacement of Peripheral and Midline Catheters

  1. There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults [36, 140, 141]. Category 1B
  2. No recommendation is made regarding replacement of peripheral catheters in adults only when clinically indicated [142–144]. Unresolved issue
  3. Replace peripheral catheters in children only when clinically indicated [32, 33]. Category 1B
  4. Replace midline catheters only when there is a specific indication. Category II

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Replacement of CVCs, Including PICCs and Hemodialysis Catheters

  1. Do not routinely replace CVCs, PICCs, hemodialysis catheters, or pulmonary artery catheters to prevent catheter-related infections. Category IB
  2. Do not remove CVCs or PICCs on the basis of fever alone. Use clinical judgment regarding the appropriateness of removing the catheter if infection is evidenced elsewhere or if a noninfectious cause of fever is suspected. Category II
  3. Do not use guidewire exchanges routinely for non-tunneled catheters to prevent infection. Category IB
  4. Do not use guidewire exchanges to replace a non-tunneled catheter suspected of infection. Category IB
  5. Use a guidewire exchange to replace a malfunctioning non-tunneled catheter if no evidence of infection is present. Category IB
  6. Use new sterile gloves before handling the new catheter when guidewire exchanges are performed. Category II

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Umbilical Catheters

  1. Remove and do not replace umbilical artery catheters if any signs of CRBSI, vascular insufficiency in the lower extremities, or thrombosis are present [145]. Category II
  2. Remove and do not replace umbilical venous catheters if any signs of CRBSI or thrombosis are present [145]. Category II
  3. No recommendation can be made regarding attempts to salvage an umbilical catheter by administering antibiotic treatment through the catheter. Unresolved issue
  4. Cleanse the umbilical insertion site with an antiseptic before catheter insertion. Avoid tincture of iodine because of the potential effect on the neonatal thyroid. Other iodine-containing products (e.g., povidone iodine) can be used [146– 150]. Category IB
  5. Do not use topical antibiotic ointment or creams on umbilical catheter insertion sites because of the potential to promote fungal infections and antimicrobial resistance [88, 89]. Category IA
  6. Add low-doses of heparin (0.25—1.0 U/ml) to the fluid infused through umbilical arterial catheters [151–153]. Category IB
  7. Remove umbilical catheters as soon as possible when no longer needed or when any sign of vascular insufficiency to the lower extremities is observed. Optimally, umbilical artery catheters should not be left in place >5 days [145, 154]. Category II
  8. Umbilical venous catheters should be removed as soon as possible when no longer needed, but can be used up to 14 days if managed aseptically [155, 156]. Category II
  9. An umbilical catheter may be replaced if it is malfunctioning, and there is no other indication for catheter removal, and the total duration of catheterization has not exceeded 5 days for an umbilical artery catheter or 14 days for an umbilical vein catheter. Category II

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Peripheral Arterial Catheters and Pressure Monitoring Devices for Adult and Pediatric Patients

  1. In adults, use of the radial, brachial or dorsalis pedis sites is preferred over the femoral or axillary sites of insertion to reduce the risk of infection [46, 47, 157, 158]. Category IB
  2. In children, the brachial site should not be used. The radial, dorsalis pedis, and posterior tibial sites are preferred over the femoral or axillary sites of insertion [46]. Category II
  3. A minimum of a cap, mask, sterile gloves and a small sterile fenestrated drape should be used during peripheral arterial catheter insertion [47, 158, 159]. Category IB
  4. During axillary or femoral artery catheter insertion, maximal sterile barriers precautions should be used. Category II
  5. Replace arterial catheters only when there is a clinical indication. Category II
  6. Remove the arterial catheter as soon as it is no longer needed. Category II
  7. Use disposable, rather than reusable, transducer assemblies when possible [160–164]. Category IB
  8. Do not routinely replace arterial catheters to prevent catheter-related infections [165, 166, 167, 168]. Category II
  9. Replace disposable or reusable transducers at 96-hour intervals. Replace other components of the system (including the tubing, continuous-flush device, and flush solution) at the time the transducer is replaced [37, 161]. Category IB
  10. Keep all components of the pressure monitoring system (including calibration devices and flush solution) sterile [160, 169–171]. Category IA
  11. Minimize the number of manipulations of and entries into the pressure monitoring system. Use a closed flush system (i.e, continuous flush), rather than an open system (i.e, one that requires a syringe and stopcock), to maintain the patency of the pressure monitoring catheters [163, 172]. Category II
  12. 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 [163]. Category IA
  13. Do not administer dextrose-containing solutions or parenteral nutrition fluids through the pressure monitoring circuit [163, 173, 174]. Category IA
  14. Sterilize reusable transducers according to the manufacturers’ instructions if the use of disposable transducers is not feasible [163, 173–176]. Category IA

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Replacement of Administration Sets

  1. In patients not receiving blood, blood products or fat emulsions, replace administration sets that are continuously used, including secondary sets and add-on devices, no more frequently than at 96-hour intervals, [177] but at least every 7 days [178–181]. Category IA
  2. No recommendation can be made regarding the frequency for replacing intermittently used administration sets.Unresolved issue
  3. No recommendation can be made regarding the frequency for replacing needles to access implantable ports. Unresolved issue
  4. Replace tubing used to administer blood, blood products, or fat emulsions (those combined with amino acids and glucose in a 3-in-1 admixture or infused separately) within 24 hours of initiating the infusion [182–185]. Category IB
  5. Replace tubing used to administer propofol infusions every 6 or 12 hours, when the vial is changed, per the manufacturer’s recommendation (FDA website Medwatch) [186]. Category IA
  6. No recommendation can be made regarding the length of time a needle used to access implanted ports can remain in place. Unresolved issue

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Needleless Intravascular Catheter Systems

  1. Change the needleless components at least as frequently as the administration set. There is no benefit to changing these more frequently than every 72 hours. [39, 187–193]. Category II
  2. Change needleless connectors no more frequently than every 72 hours or according to manufacturers’ recommendations for the purpose of reducing infection rates [187, 189, 192, 193]. Category II
  3. Ensure that all components of the system are compatible to minimize leaks and breaks in the system [194]. Category II
  4. 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 [189, 192, 194–196]. Category IA
  5. Use a needleless system to access IV tubing. Category IC
  6. When needleless systems are used, a split septum valve may be preferred over some mechanical valves due to increased risk of infection with the mechanical valves [197–200]. Category II

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Performance Improvement

Use hospital-specific or collaborative-based performance improvement initiatives in which multifaceted strategies are "bundled" together to improve compliance with evidence-based recommended practices [15, 69, 70, 201–205]. Category IB

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