A catheter in a peripheral vein has a much lower chance of infection than a catheter in a central vein.  In fact, the majority of serious catheter-related infections are associated with CVCs, not peripheral lines.  Since infection risk increases the longer a catheter remains in place, providers must continually evaluate the need for every CVC.  If a CVC is no longer required and peripheral access has been established, the CVC should be removed.

The insertion site should be palpated daily, with thorough inspection of the site if local tenderness or other signs of a possible infection are noted. If purulence is ever noticed at the insertion site, remove the catheter immediately and place a new catheter at a different site.  Placement of a new catheter over a guidewire in the presence of bacteremia is unacceptable, because the infection likely originated from the skin tract between the insertion site and the vein.  Removal of a CVC for fever alone is unnecessary.

A strategy of replacing catheters at scheduled time intervals does not reduce rates of CVC-related bacteremia.  Likewise, routine guidewire exchanges also fail to prevent infections.  If no infection is suspected, catheter replacement over a guidewire is an accepted technique for replacing a malfunctioning catheter or exchanging a pulmonary artery catheter for a CVC.  Guidewire exchange should be done using all the techniques and procedures for inserting a CVC.

Of note, CVC insertion and removal exposes patients to the risk for potential air embolus.  To minimize this risk, providers should ensure the patient is lying flat (or in slight Trendelenberg) when removing a CVC.  Instruct patients to take in a deep breath, and then pull the line when the patient exhales.  Apply firm pressure to the site for at least 10 minutes, longer if the patient has an underlying bleeding tendency.

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