/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/npg/,

/clinical/cckm-tools/content/cpg/npg/name-98990-en.cckm

201705150

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Nursing Practice Guidelines

Prevention of Intravascular Catheter-Related Infections Guideline at a Glance (Nursing Practice Guideline)

Prevention of Intravascular Catheter-Related Infections Guideline at a Glance (Nursing Practice Guideline) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Nursing Practice Guidelines




1








Guideline Title: Prevention of Intravascular Catheter-Related Infections
Effective Date: April 2017
Approved By: Nursing Practice Guidelines Committee; Nursing Practice Council

Statement of Review, March 2017
This externally adopted guideline, Guidelines for the Prevention of Intravascular Catheter-Related
Infections, authored by O’Grady, et al (2011) has been reviewed by UW Health’s internal content
experts and the Central Line Associated Blood Stream Infection (CLABSI) Reduction Workgroup.
This guideline remains the best available evidence to guide nursing practice related to the
insertion and maintenance of intravascular catheters. The Nursing Practice Guidelines Committee
and the Nursing Practice Council approve the continued use of this document. This guideline topic
will be reviewed again in March 2020 or sooner if new evidence becomes available.

I. Guideline Overview
This content is extracted from the adopted source document: O’Grady, N. P., Alexander, M.,
Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Healthcare Infection Control Practices
Advisory Committee (HICPAC), & et al. (2011). Guidelines for the prevention of intravascular
catheter-related infections. Please refer to the source guideline for complete information.

In the United States, 15 million central vascular catheter (CVC) days (i.e., the total number of days of
exposure to CVCs among all patients in the selected population during the selected time period) occur
in intensive care units (ICUs) each year. Studies have variously addressed catheter-related
bloodstream infections (CRBSI). These infections independently increase hospital costs and length of
stay, but have not generally been shown to independently increase mortality. While 80,000 CRBSIs
occur in ICUs each year, a total of 250,000 cases of BSIs have been estimated to occur annually, if
entire hospitals are assessed. By several analyses, the cost of these infections is substantial, both in
terms of morbidity and financial resources expended. To improve patient outcome and to reduce
healthcare costs, there is considerable interest by healthcare providers, insurers, regulators, and
patient advocates in reducing the incidence of these infections. This effort should be multidisciplinary,
involving healthcare professionals who order the insertion and removal of CVCs, those personnel who
insert and maintain intravascular catheters, infection control personnel, healthcare managers including
the chief executive officer (CEO) and those who allocate resources and patients who are capable of
assisting in the care of their catheters. (O’Grady, et al., 2011, pp. 8-9)

Nursing-specific recommendations have been extracted from the source document Guidelines for the
Prevention of Intravascular Catheter-Related Infections created by the CDC to cover the following
areas:
A. Education, Training and Staffing
B. Selection of Catheters and Sites
1. Peripheral Catheters and Midline Catheters
2. Central Venous Catheters
C. Hand Hygiene and Aseptic Technique
D. Skin Preparation
E. Catheter Site Dressing Regimens
F. Catheter Securement Devices
G. Replacement of Peripheral and Midline Catheters
H. Replacement of CVCs, including PICCs
I. Replacement of Administration Sets
J. Needleless Intravascular Catheter Systems

University of Wisconsin Hospitals and Clinics
Nursing Practice Guideline At-a-Glance



Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Last Revised: 04/2017EArsenaultknudsen@uwhealth.org
2
Note: The following content is only an overview. Refer to the source guideline CDC Guidelines for
the Prevention of Intravascular Catheter-Related Infection whenever necessary for more
information.
II. Practice Recommendations
NOTE: Letters and numbers in parenthesis indicate the level of evidence (see section IV).
Education, Training and Staffing
• Designate only trained personnel who demonstrate competence for the insertion and
maintenance of peripheral and central intravascular catheters. (IA)
Selection of Catheters and Sites
Peripheral Catheters and Midline Catheters
• In adults, use an upper-extremity site for catheter insertion. Replace a catheter inserted in a
lower extremity site to an upper extremity site as soon as possible. (II)
• In pediatric patients, the upper or lower extremities or the scalp (in neonates or young
infants) can be used as the catheter insertion site. (II)
• Select catheters on the basis of the intended purpose and duration of use, known infectious
and non-infectious complications (e.g., phlebitis and infiltration), and experience of individual
catheter operators. (IB)
• Avoid the use of steel needles for the administration of fluids and medication that might cause
tissue necrosis if extravasation occurs. (IA)
• Use a midline catheter or peripherally inserted central catheter (PICC), instead of a short
peripheral catheter, when the duration of IV therapy will likely exceed six days. (II)
• Evaluate the catheter insertion site daily by palpation through the dressing to discern
tenderness and by inspection if a transparent dressing is in use. Gauze and opaque dressings
should not be removed if the patient has no clinical signs of infection. If the patient has local
tenderness or other signs of possible CRBSI, an opaque dressing should be removed and the
site inspected visually. (II)
• Remove peripheral venous catheters if the patients develop signs of phlebitis (warmth,
tenderness, erythema or palpable venous cord), infection, or a malfunctioning catheter. (IB)
Central Venous Catheters
• Avoid using the femoral vein for central venous access in adult patients. (IA)
• Use a subclavian site, rather than a jugular or a femoral site, in adult patients to minimize
infection risk for nontunneled CVC placement. (IB)
• Promptly remove any intravascular catheter that is no longer essential. (IA)
• When adherence to aseptic technique cannot be ensured (i.e., catheters inserted during a
medical emergency), replace the catheter as soon as possible, i.e., within 48 hours. (IB)
Hand Hygiene and Aseptic Technique
• Perform hand hygiene procedures, either by washing hands with conventional soap and water
or with alcohol-based hand rubs. Hand hygiene should be performed before and after
palpating catheter insertion sites as well as before and after inserting, replacing, accessing,

Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Last Revised: 04/2017EArsenaultknudsen@uwhealth.org
3
repairing, or dressing an intravascular catheter. Palpation of the insertion site should not be
performed after the application of antiseptic, unless aseptic technique is maintained. (IB)
• Maintain aseptic technique for the insertion and care of intravascular catheters. (IB)
• Wear clean gloves, rather than sterile gloves, for the insertion of peripheral intravascular
catheters, if the access site is not touched after the application of skin antiseptics. (IC )
• Sterile gloves should be worn for the insertion of arterial, central, and midline catheters. (IA)
• Use new sterile gloves before handling the new catheter when guidewire exchanges are
performed. (II)
• Wear either clean or sterile gloves when changing the dressing on intravascular catheters. (IC)
Skin Preparation
• Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, or alcoholic
chlorhexidine gluconate solution) before peripheral venous catheter insertion. (IB)
• Antiseptics should be allowed to dry according to the manufacturer’s recommendation prior to
placing the catheter. (IB)
Catheter Site Dressing Regimens
• Use either sterile gauze or sterile, transparent, semipermeable dressing to cover the catheter
site. (IA)
• If the patient is diaphoretic or if the site is bleeding or oozing, use a gauze dressing until this
is resolved. (II)
• Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled. (IB)
• Do not use topical antibiotic ointment or creams on insertion sites, except for dialysis
catheters, because of their potential to promote fungal infections and antimicrobial resistance.
(IB)
• Do not submerge the catheter or catheter site in water. Showering should be permitted if
precautions can be taken to reduce the likelihood of introducing organisms into the catheter
(e.g., if the catheter and connecting device are protected with an impermeable cover during
the shower). (IB)
• Monitor the catheter sites visually when changing the dressing or by palpation through an
intact dressing on a regular basis, depending on the clinical situation of the individual patient.
If patients have tenderness at the insertion site, fever without obvious source, or other
manifestations suggesting local or bloodstream infection, the dressing should be removed to
allow thorough examination of the site. (IB)
• Encourage patients to report any changes in their catheter site or any new discomfort to their
provider. (II)
Catheter Securement Devices
• Use a sutureless securement device to reduce the risk of infection for intravascular catheters.
(II)
Replacement of Peripheral and Midline Catheters
• There is no need to replace peripheral catheters more frequently than every 72-96 hours to
reduce risk of infection and phlebitis in adults. (IB)

Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Last Revised: 04/2017EArsenaultknudsen@uwhealth.org
4
• No recommendation is made regarding replacement of peripheral catheters in adults only
when clinically indicated. (Unresolved Issue)
• Replace peripheral catheters in children only when clinically indicated. (IB)
• Replace midline catheters only when there is a specific indication. (II)
Replacement of CVCs, Including PICCs and Hemodialysis Catheters
• 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. (II)
Replacement of Administration Sets
• 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, but at least every 7 days. (IA)
• No recommendation can be made regarding the frequency for replacing intermittently used
administration sets. (Unresolved Issue)
• No recommendation can be made regarding the frequency for replacing needles to access
implantable ports. (Unresolved Issue)
Needleless Intravascular Catheter Systems
• Ensure that all components of the system are compatible to minimize leaks and breaks in the
system. (II)
• 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. (IA)
• Use a needleless system to access IV tubing. (IC)
III. Pertinent Resources
A. UWHC Policy
• Policy 1.56AP Central Vascular Access Device Use, Maintenance and Removal (Adult &
Pediatric)
• Policy 1.11A Arterial Catheter/Insertion, Maintenance, Blood Drawing and
Discontinuation (Adult)
• Policy 1.14AP Invasive and Non-invasive Hemodynamic Monitoring
• Policy 1.23AP Continuous Peripheral Intravenous Therapy
• Policy 1.28AP Care of Hemodialysis/Apheresis Catheters
• Policy 1.55 A Midline Intravenous Peripheral Catheters: Use, Maintenance and
Removal (Adult)
• Policy 3.26 Arterial Puncture
• Policy 2.2.6 Blood and Blood Component Transfusion (Requiring Pre-Transfusion
Testing)
• Policy 11.11 Arterial Blood Specimen Drawing via Direct Radial Artery Puncture
• Policy 1507.P014 Blood Culture Collection
B. Patient Education Resources

Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Last Revised: 04/2017EArsenaultknudsen@uwhealth.org
5
• Health Facts For You (HFFY) 4237 Port – An Implantable Vascular Access Device
• HFFY 4324 Hickman® Catheter Care
• HFFY 4558 Groshong® Catheter Care
• HFFY 5093 Understanding your Peripherally Inserted Central Catheter (PICC)
• HFFY 5754 Port Removal in the Breast Clinic
• HFFY 5879 Drawing Blood Through Your Child’s Central Line Using a Vacutainer
• HFFY 5958 Port Placement – Interventional Radiology
C. Clinical Tools
• UW Health Guidelines for Flushing / Locking of Venous Access Devices- Adult /
Pediatric – Inpatient/Ambulatory Clinical Practice Guideline
• CLABSI Prevention Website on U-Connect:
i. Infusion Nursing Society’s Infusion Therapy Standards of Practice
ii. Click on “Resources” tab to see multiple documents on the insertion,
maintenance and practices for CVADs and Midline Catheters
• PIV, Midline, PICC-Catheter Comparison
• TRIP: CVAD Occlusion Management
• TRIP: IV Extravasation Prevention and Management
• TRIP: Petroleum Jelly for CVAD Removal
• TRIP: Two-person Adult Central Vascular Access Device Dressing Change
IV. Levels of Evidence
V. Key Reference
O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Healthcare
Infection Control Practices Advisory Committee (HICPAC), & et al. (2011). Guidelines for the
prevention of intravascular catheter-related infections. CDC, Retrieved from
https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines.pdf
Category IA
Strongly recommended for implementation and strongly supported by well-
designed experimental, clinical, or epidemiologic studies.
Category IB
Strongly recommended for implementation and supported by some experimental,
clinical, or epidemiologic studies and a strong theoretical rationale; or an accepted
practice (e.g., aseptic technique) supported by limited evidence.
Category IC Required by state or federal regulations, rules, or standards.
Category II
Suggested for implementation and supported by suggestive clinical or
epidemiologic studies or a theoretical rationale.
Unresolved Issue
Represents an unresolved issue for which evidence is insufficient or no consensus
regarding efficacy exists.
Rating scheme above reflects that which is utilized within the primary source: O’Grady, N.P. et al.
(2011) Guidelines for the prevention of intravascular catheter-related infections.