Central Venous Catheter Insertion and Maintenance

Excessive manipulation of catheters increases the risk for CVC-related BSI, probably because of the greater risk for a breach in aseptic technique each time the catheter is accessed.  Whenever possible, providers should limit the number of times a line is accessed in order to minimize this risk.  Performing non-emergent blood draws at scheduled times (regardless of when they are ordered) is one possible strategy to limit catheter manipulation.

The multiple demands on critical care providers can contribute to catheter-related infections. For example, studies have shown that reducing the nurse:patient ratio from 1:1 to 1:2 independently increases the risk for developing a CVC-related BSI.  This effect is possibly due to hurried providers bypassing standard precautionary steps.  Prior to accessing any line, hands should be washed, gloves should be worn, and the hub should be sterilized with an alcohol swab. Although alcohol possesses antimicrobial properties, the friction from actually wiping a hub is the most important feature of this step. Providers should pay keen attention to the potential for touch contamination when accessing a hub. 

Catheters must be properly anchored after insertion.  Unfortunately, many providers underestimate the importance of this step.  A loosely-anchored catheter slides back and forth, increasing the risk for contamination of the insertion tract. Since skin flora are the most common infecting organisms in CVC-related BSIs, proper anchoring is strongly recommended. Likewise, the contamination shield should always be used on pulmonary artery catheters.

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