Device itself | Institute careful needs assessment prior to insertion of any intravascular device. | Avoid unnecessary insertions. Use of peripheral catheter, midline, or PICC line should be considered if appropriate. |
| Choose least thrombogenic material for type of device being inserted based on the needs assessment. | Polyvinylchloride > polyurethane > silicone > steel with respect to thrombogenecity and colonization with certain microorganisms. |
| Consider use of antiseptic-antimicrobial bonded devices or use of subcutaneous cuffs impregnated with antimicrobial agent. | Significant reductions in catheter infection rates (50%–80%) have been found in several randomized controlled trials using chlorhexidine silver-bonded catheters, silver-impregnated cuffs, and antibiotic-coated catheters. |
| Minimize the number of lumens and the number of accesses whenever possible. | This strategy is somewhat controversial, since several but not all studies have demonstrated an increased risk of catheter infection with multilumen lines. A greater number of lumens will increase the frequency of entry to the system, which is associated with a greater risk of catheter-related infection. |
Device insertion | Choose site associated with least risk for local and systemic device-related infection. | Risk of local and systemic catheter-related infection is independently associated with density of flora at the catheter insertion site; femoral > jugular/subclavian > antecubital fossa. |
| Use aseptic technique. | Good hand washing and use of maximal barrier precautions (masks, sterile drapes, gloves, gown) are associated with less risk of catheter-related bacteremia than minimal barrier precautions (mask, sterile gloves, small drapes). |
| Insertion is done by skilled operators. | Organized, specifically trained IV teams have been associated with lower catheter infection rates, but the key ingredient is a highly skilled operator with excellent technique. Difficulty of insertion has been associated with higher local catheter-related infection rates. |
| Place device in as controlled an environment as possible. | Emergency catheter insertions are associated with a higher risk of infection than elective placement. |
| Use prophylactic antibiotics at time of insertion. | Prospective randomized controlled trials have shown no benefit, and prophylactic antibiotics are not generally recommended. |
Catheter site care | Use cutaneous antiseptic with maximal efficacy, ease of application, and compliance with recommendations for usage. |
Chlorhexidine (0.5% tincture or 2% aqueous) may offer best approach to cutaneous antisepsis considering all criteria for use. Povidone iodine, although effective, is often used improperly despite best efforts to improve compliance. |
| Apply topical antiseptics/antimicrobials at the insertion site. | Clinical trials to date have shown only marginal or no benefit but may be of benefit in selected settings. |
| Choose dry gauze or other permeable dressings for site care. | Transparent semipermeable dressings have been associated with both a significantly increased density of flora at the catheter insertion site and local catheter-related infection rates. Some prospective studies have demonstrated a significantly increased risk of catheter-related bacteremia. |
Catheter care | Minimize the number of interruptions to the integrity of the line. | With TPN there is an increased risk of catheter-related infection with line violations. The system should be kept closed as much as possible. |
Delivery system | Minimize the number of interruptions to the integrity of the delivery system. | With TPN the risk of catheter-related infections increases significantly with interruptions to the integrity of the system. |
| Change administration set every 72 hours. | Changes of the administration sets at 72-hour intervals have not been shown to be associated with any increased risk of catheter-related infection compared to changes at 24-hour intervals. |