Central line infections: prevention

Critical Care

Employ aseptic technique during placement, which includes full sterile drape, sterile gown and gloves, hat and mask . Use the subclavian vein when possible (although direct comparisons of SC and IJV have not been made). Single lumen catheters are associated with a lower infection rate and should be used when clinically feasible. Heparin-bonded catheters reduce both thrombosis and infection. Antibiotic-impregnated catheters reduce in incidence of catheter colonization and blood stream infection.

Implementation of a central line checklist has been shown to be extremely efficacious at reducing the incidence of CRBSI.

Catheter-Related Blood Stream Infection (CRBSI)

Epidemiology

  • Incidence: ~ 5% per person with central venous catheter
  • Mortality: unknown, however the mortality rate of all patients with a nosocomial bloodstream infection is ~ 35%
  • Cost: up to $50,000 per infection

Prevention

  • Technique: aseptic (sterile full body drape, gown, gloves. Hat, mask)
  • Site: subclavian preferred (although IJV and SC never directly compared)
  • Catheter: single lumen (if possible), heparin-bonded, antibiotic impregnated
  • Biopatch: proven in multiple studies (although always placed on the arterial line as well)
  • Expeditious Removal: remove CVCs as soon as not needed
  • Checklist: shown to dramatically reduce the incidence of CRBSI

Sources

    Miller, RD et al. Miller’s Anesthesia, 7th edition, Churchill Livingstone: p 1292. 2009

    JAMA. 2009 Mar 25;301(12):1285-7

    [PubMed: 19318651]

    Crit Care Med. 2004 Oct;32(10):2150-2

    [PubMed: 15483409]

    Crit Care Med. 2004 Oct;32(10):2150-2

    [PubMed: 15483409]

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2009

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