Central Venous Access: Prevention of Infectious Complications.
- For immunocompromised patients and high-risk neonates, administer intravenous antibiotic prophylaxis on a case-by-case basis.
- Intravenous antibiotic prophylaxis should not be administered routinely.
- In preparation for the placement of central venous catheters, use aseptic techniques (e.g. , hand washing) and maximal barrier precautions (e.g. , sterile gowns, sterile gloves, caps, masks covering both mouth and nose, and full-body patient drapes).
- A chlorhexidine-containing solution should be used for skin preparation in adults, infants, and children.
- For neonates, the use of a chlorhexidine-containing solution for skin preparation should be based on clinical judgment and institutional protocol.
- If there is a contraindication to chlorhexidine, povidone-iodine or alcohol may be used as alternatives.
- Unless contraindicated, skin preparation solutions should contain alcohol.
- If there is a contraindication to chlorhexidine, povidone-iodine or alcohol may be used. Unless contraindicated, skin preparation solutions should contain alcohol.
- Catheters coated with antibiotics or a combination of chlorhexidine and silver sulfadiazine should be used for selected patients based on infectious risk, cost, and anticipated duration of catheter use.
- Catheters containing antimicrobial agents are not a substitute for additional infection precautions.
- Catheter insertion site selection should be based on clinical need.
- An insertion site should be selected that is not contaminated or potentially contaminated (e.g. , burned or infected skin, inguinal area, adjacent to tracheostomy or open surgical wound).
- In adults, selection of an upper body insertion site should be considered to minimize the risk of infection.
- The use of sutures, staples, or tape for catheter fixation should be determined on a local or institutional basis.
- Transparent bio-occlusive dressings should be used to protect the site of central venous catheter insertion from infection.
- Unless contraindicated, dressings containing chlorhexidine may be used in adults, infants, and children.
- For neonates, the use of transparent or sponge dressings containing chlorhexidine should be based on clinical judgment and institutional protocol.
- The duration of catheterization should be based on clinical need.
- The clinical need for keeping the catheter in place should be assessed daily.
- Catheters should be removed promptly when no longer deemed clinically necessary.
- The catheter insertion site should be inspected daily for signs of infection.
- The catheter should be changed or removed when catheter insertion site infection is suspected.
- When a catheter-related infection is suspected, replacing the catheter using a new insertion site is preferable to changing the catheter over a guidewire.
- Catheter access ports should be wiped with an appropriate antiseptic before each access when using an existing central venous catheter for injection or aspiration.
- Central venous catheter stopcocks or access ports should be capped when not in use.
- Needleless catheter access ports may be used on a case-by-case basis.
Source: Practice Guidelines for Central Venous Access: A Report by the American Society of Anesthesiologists Task Force on Central Venous Access
