Central line infections: prevention
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)
- 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
- 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