Although these have been shown in randomized controlled trials to reduce infection, they have yet to be widely accepted. A number of advances have been made to try and reduce the incidence of infection via this route, including gauze wrapping containing povidone-iodine and a specialist hub designed by a Spanish research group. The access hubs of the CVC are another important potential source of introducing infection, and this possibility must be reduced by careful adherence to cleaning and aseptic non-touch technique (ASNTT) when using the hubs and connecting infusions. A 2006 review concluded that a permeable dressing leads to lower moisture pooling and colonization levels and should be recommended. The use of transparent impermeable dressings has been suggested to increase skin colonization and lead to infection because of moisture trapping. However, a large study of 343 patients who were having routine catheter insertion showed a 2.3% rate of infection when dressing with both gauze and an overlying transparent dressing was used. These have the clear advantage of allowing constant inspection of the site to identify local infection, pressure damage, or other complications visible at the insertion site without the need for a dressing change. The most commonly used dressings comprise an adherent transparent polyurethane film. ĭressings are an essential item to contribute to keeping CVCs and their insertion site clean and dry. It has been shown to result in lower rates of sepsis related to CVCs but has also been demonstrated to increase the risk of resistant bacterial infections and Candida colonization and subsequent infection. Therefore we recommend the use of a 2% chlorhexidine-containing solution or purpose-made applicator.The use of antibacterial preparations on the site after insertion is not routinely recommended. This risk has been shown in a randomized controlled prospective trial to be reduced sixfold by skin cleansing with chlorhexidine solution. The majority of catheter-associated infections have been shown to be related to skin colonization. The start of any procedure where the catheter dressings are exposed should begin with skin cleansing. Insertion and care should always be performed under sterile conditions with appropriate hand hygiene, draping, and sterile materials. Recommendations have been established and published by the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC) to guide health care providers in the use of evidence-based practices for central line care. The development of central line-associated bloodstream infection (CLABSI) may increase the patients’ length of stay by up to three weeks for an average additional healthcare cost of $33,000. Additionally, CVC infections are associated with increased morbidity, mortality, length of stay, healthcare costs, diagnostic tests, and antimicrobial use. Ĭentral line infections are more common than any other healthcare-related infection and account for 33,000 deaths per year. Unfortunately, the presence of indwelling CVCs increases the risk of the formation of thrombi, emboli, and infection than patients with peripheral catheters by 200%. Central venous catheters (CVC) are frequently used in critical care units, hemodialysis units, and oncology units for the administration of intravenous fluids, medications, blood products, parenteral nutrition, vasoactive medications, hemodialysis, and hemodynamic monitoring.
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