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Appendix B

Summary of Recommended Frequency of Replacements for Catheters, Dressings, Administration Sets, and Fluids

Please note: An erratum has been published for this article. To view the erratum, please click here.


Catheter Replacement and 
relocation of device
Replacement of 
catheter site dressing
Replacement of 
administration sets
Hang time for parenteral fluids
Peripheral venous catheters















Replacement and relocation of device














Replace dressing when the catheter is removed or replaced, or when the dressing becomes damp, loosened, or soiled. Replace dressings more frequently in diaphoretic patients. In patients who have large bulky dressings that prevent palpation or direct visualization of the catheter insertion site, remove the dressing and visually inspect the catheter at least daily and apply a new dressing.


Replace intravenous tubing, including add-on devices, no more frequently than at 72-hour intervals unless clinically indicated. Replace tubing used to administer blood, blood products, or lipid emulsions within 24 hours of initiating the infusion.
No recommendation for replacement of tubing used for intermittent infusions. Consider short extension tubing connected to the catheter to be a portion of the device. Replace such extension tubing when the catheter is changed.
No recommendation for the hang time of intravenous fluids, including nonlipid-containing parenteral nutrition fluids. Complete infusion of lipid-containing parenteral nutrition fluids (e.g., 3-in-1 solutions) within 24 hours of hanging the fluid. Complete infusion of lipid emulsions alone within 12 hours of hanging the fluid. Complete infusions of blood products within 4 hours of hanging the product.

Midline catheters









In adults, replace catheter and rotate site no more frequently than every 72– 96 hours. Replace catheters inserted under emergency basis and insert a new catheter at a different site within 48 hours. In pediatric patients, do not replace peripheral catheters unless clinically indicated.
As above.


 

 

 

As above.







As above.









Peripheral arterial catheters



No recommendation for the frequency of the catheter replacement.

Replace dressing when the catheter is replaced, or when the dressing becomes damp, loosened, or soiled, or when inspection of the site is necessary. Replace the intravenous tubing at the time the transducer is replaced (i.e., 72-hour intervals).

Replace the flush solution at the time the transducer is replaced (i.e., 72- hour intervals).

Central venous catheters including peripherally inserted central catheters and hemodialysis catheters In adults, do not replace catheters routinely to prevent catheter-related infection. In pediatric patients, no recommendation for the frequency of catheter replacement. Replace disposable or reusable transducers at 72-hour intervals. Replace continuous flush device at  the time the transducer is replaced. Replace gauze dressings every 2 days and transparent dressings every 7 days on short-term catheters. Replace the dressing when the catheter is replaced, or when the dressing becomes damp, loosened, or soiled, or when inspection of the site is necessary. Replace intravenous tubing and add-on devices no more frequently than at 72-hour intervals. Replace tubing used to administer blood products or lipid emulsions within 24 hours of initiating the infusion. No recommendation for the hang time of intravenous fluids, including nonlipid-containing parenteral nutrition fluids. Complete infusions of lipid-containing fluids within 24 hours of hanging the fluid.
Pulmonary artery
Do not routinely replace catheters. As above.
As above.
As above.
Umbilical catheters








Do not replace catheter to prevent catheter-related infection.

Do not routinely replace catheters.



Not applicable.








Replace intravenous tubing and add-on devices no more frequently than at 72-hour intervals. Replace tubing used to administer blood products or lipid emulsions within 24 hours of initiating the infusion.


No recommendation for the hang time of intravenous fluids, including nonlipid-containing parenteral nutrition fluids. Complete infusion of lipid-containing fluids within 24 hours of hanging the fluid. Includes nontunneled catheters, tunneled catheters, and totally implanted devices.


Healthcare Infection Control Practices Advisory Committee
Membership List, May 2001

Chairman: Robert A. Weinstein, M.D., Cook County Hospital, Chicago, Illinois.
Co-Chairman:
Jane D. Siegel, M.D., University of Texas Southwestern Medical Center, Dallas, Texas.
Executive Secretary:
Michele L. Pearson, M.D., Medical Epidemiologist, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Members: Raymond Y.W. Chinn, M.D., Sharp Memorial Hospital, San Diego, California; Alfred DeMaria, Jr., M.D., Massachusetts Department of Public Health, Jamaica Plain, Massachusetts; James T. Lee, M.D., PhD., University of Minnesota and VA Medical Center, St. Paul, Minnesota; Ramon E. Moncada, M.D., Coronado Physician’s Medical Center, Coronado, California; William A. Rutala, PhD., University of North Carolina School of Medicine, Chapel Hill, North Carolina; William E. Scheckler, M.D., University of Wisconsin Medical School, Madison, Wisconsin; Beth H. Stover, Kosair Children’s Hospital, Louisville, Kentucky; Majorie A. Underwood, Mt. Diablo Medical Center, Concord, California.

Disclosure of Financial Interests or Relationships

Dennis Maki: Research grant sponsorship from Arrow, 3M, Becton-Dickinson, Johnson and Johnson; consultant for Micrologix. 
Issam Raad: Holds two patents associated with minocylcine-rifampin catheters. Patents are the property of University of Texas M.D. Anderson Cancer Center, Baylor College of Medicine and Wake Forest University. Both patents are liscensed to Cook Critical Care with royalty rights to the institutions involved, and a percentage of royalties to the inventors. Co-inventor of patents associated with minocycline-EDTA flush solution. These patents are not yet licensed. Becton-Dickenson holds rights to this technology. Grant and research support from Kimberly Clark, Becton-Dickinson, Abbott Labs, Immunomedics, and Cook Critical Care, Inc.

Stephen Heard: Research grant sponsorship from Cook Critical Care, Inc., and Edwards Lifesciences.
E. Patchen Dellinger:
Research support, lectured for honoraria, or served on advisory boards for SmithKline Beecham, Wyeth-Ayerst, Pharmacia, Bristol-Myers Squibb, Zeneca, Pfizer, Aventis, Hoffman-LaRoche, Arrow, NABI, Ortho-McNeil, Park-Davis, Abbott, ICOS, Immunex, Chiron, Searle, Ican, Inc., and Centercor.
Andrienne Randolph:
Research support from Cook Critical Care.
Leonard Mermel:
Research support from Arrow, Johnson and Johnson; consultant to 3M.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.


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