CDC Guidelines: Vascular catheter infections

Skin Preparation:

•Catheter insertion site should be cleaned with an antiseptic (70% alcohol, tincture of iodine, an iodophor or chlorhexidine gluconate) before peripheral venous catheter insertion.

•Catheter insertion site should be cleaned with a >0.5% chlorhexidine preparation with alcohol before central venous catheter and peripheral arterial catheter insertion and during dressing changes.

•No comparison has been made between using chlorhexidine preparations with alcohol and povidone-iodine in alcohol to prepare clean skin.

•No recommendation can be made for the safety or efficacy of chlorhexidine in infants aged <2 months.

•Antiseptics should be allowed to dry according to the manufacturer’s recommendation prior to placing the catheter.

•Chlorhexidine-impregnated dressings with an FDA-cleared label that specifies a clinical indication for reducing catheter-related bloodstream infection (CRBSI) or catheter-associated bloodstream infection (CABSI) are recommended to protect the insertion site of short-term, non-tunneled central venous catheters.

Chlorhexidine-impregnated dressings are NOT recommended to protect the site of short-term, non-tunneled central venous catheters for premature neonates due to risk of serious adverse skin reactions.

Peripheral catheters and midline catheters:

• Catheter site should be evaluated daily by palpation through the dressing and inspection (if dressing is transparent) looking for tenderness or signs of infection. If initial signs of infection are present via palpation on a non-transparent dressing, the dressing should be removed and the catheter should be subject to further visualization at the insertion site.

• Catheter should be removed if signs of phlebitis (warmth, tenderness, erythema or palpable venous cord), infection, or a malfunctioning catheter are present.

• There is no need to replace peripheral catheters more frequently than every 72–96 hours to reduce risk of infection and phlebitis in adults.

• Routine use of systemic antibiotics before insertion or during use of peripheral or central venous catheter is not recommended.

Central venous catheters:

• Avoid using the femoral vein for central venous access in adult patients.

• For non-tunneled CVC, subclavian site is preferred in adult patients to minimize infection risk. For tunneled CVC, no recommendations have been made.

• When CVC access has been obtained during unreliable aseptic technique (medical emergency), replace the catheter as soon as possible.

• Use maximal sterile barrier precautions, including the use of a cap, mask, sterile gown, sterile gloves, and a sterile full body drape, for the insertion of CVCs, PICCs, or guidewire exchange.

• For bathing, use a 2% chlorhexidine wash for daily skin cleansing to reduce CRBSI.

Hand Hygiene and Aseptic Technique:

• Proper hand hygiene (washing or alcohol-based hand rub) should be performed before and after palpating catheter insertion sites, inserting, replacing, accessing, repairing, or dressing an intravascular catheter.

• Clean gloves (rather than sterile gloves) can be used for the insertion of peripheral intravascular catheters.

• Sterile gloves should be worn for the insertion of arterial, central, and midline catheters.

• Use new sterile gloves before handling the new catheter when guidewire exchanges are performed.

Peripheral Arterial Catheters:

• A cap, mask, sterile gloves and a small sterile fenestrated drape should be used during peripheral arterial catheter insertion.

• During axillary or femoral artery catheter insertion, maximal sterile barriers precautions should be used.

• Routine replacement of arterial catheters to prevent infection is not recommended.

• Minimize the number of manipulations of and entries into the pressure monitoring system by using a closed flush system (i.e., continuous flush), rather than an open system (i.e., one that requires a syringe and stopcock) whenever possible.