Page updated 30 April 2007
Central Venous Catheters
Insertion
- Must be carried out using strict aseptic technique. Operator must use sterile gown, drapes and gloves.
- Do not shave the site.
- Clean the skin with alcoholic chlorhexidine or alcoholic povidone iodine (check patient is not allergic to iodine), twice, allowing the solution to evaporate to dryness on each occasion.
- Unless medically contra-indicated choose the subclavian vein in preference to the jugular or femoral veins for non-tunnelled catheters as there is less risk of infection.
Fixings and Dressings
Central venous catheters must be anchored so as to prevent "to and fro"motion which increases the risk of infection. Different types of central venous catheters are fixed in different ways but, as a general rule, any "dangling" lines must be anchored so that tension and movement is not applied to the line at the entry site. The type of dressing depends on the device used.
Suggestions for dressings for central lines
| Suitable for | Type of dressing | Comments |
|---|---|---|
| Peripheral IV cannulae remaining in place for a few hours only Where the patient is able to keep their arm still. Continuous inspection required |
Non-sterile tape* only to anchor the cannula | |
| Any central venous catheter | IV-dedicated occlusive transparent dressing | Allows continous inspection of the exit site. Change at 7 days or earlier if fluid collects below the dressing or it comes off. |
| Tunnelled central venous catheters | Sterile gauze-type dressing taped in situ | Should be changed daily (in order that the site may be observed), or earlier if the dressing becomes soiled, wet or detached. |
| Any central venous catheter but only immediately following insertion and for 3 to 4 days afterwards. | Sterile gauze covered with occlusive transparent dressing | In most cases this will absorb the slight bleeding that follows many central venous catheter insertions but will avoid the need to change the dressing in the 3-4 days following insertion, thus reducing the infection risk. Unless leakage occurs, this dressing should remain in place for 2 - 4 days and then an ongoing dressing regime should be selected from the other options on this table. |
| Tunnelled central venous catheters but only after 21 days post insertion, once the tissues have fibrosed around the cuff and in the absence of exudate or signs of infection. | No dressing* | "No dressing" performed just as well as 3 types of dressing in one study comparing infection rates in patients with tunnelled central venous catheters. (Haller and Rush 1992). |
Cleaning of Exit Sites at Dressing Change
- Routine cleaning of the exit site and surrounding skin at dressing changes may be justified as part of the general hygiene of the patient to avoid odours and discomfort, and to aid dressing adherence.
- Cleaning, when it occurs, should be carried out using sterile gauze and sterile 0.9% saline using an outward "single-swipe" motion to avoid transferring bacteria to the exit site.
- The exit site should be allowed to air dry or may be dried gently using sterile gauze before applying a fresh dressing.
Ongoing Management
Do not routinely replace centrally-inserted central venous catheters over a guidewire as an infection control precaution (Pratt et al 2001).
References
Pratt R, et al. Preventing infections associated with central venous catheters. Nurs Times. 2001 Apr 12-18;97(15):36-9.
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