Central Line Clinical Practice Guideline & Rational
Central venous catheters (CVCs) are frequently used in intensive care units (ICUs) for a number of reasons (measure central venous pressure, when peripheral veins are unable to be accessed, administration of medications/therapies and aspiration of blood samples) (Conroy, 2006, p. 98). Patients in this environment already have an increased risk of infection because of their treatments. Patient treatments commonly involve invasive devices or interventions (major surgery), antibiotic therapy (raises the risk of bacterial resistance) while steroid, chemotherapy and radiation therapy all suppress the immune system (Hatler, Hebden, Kaler, & ...view middle of the document...
This means aseptic technique and sterile gloves should be used for insertion and care of a CVC. Aseptic technique is critically important to protect patients from CLABSIs; infections are caused by either intrinsic (e.g. patients own flora) or extrinsic (e.g. surrounding environment) pathogens. Asepsis therefore removes patients skin flora and ensures flora picked up from either other patients or the surrounding environment is not introduced into the patient (Mollee et al., 2011).
Raad et al. (1994) found in a randomised trial that CLABSIs were 6.3 times higher in a control group then those who had their CVC inserted under maximal barrier precautions (consisting of mask, cap, sterile gloves, gown, large drape). These findings were replicated by Abi‐Said et al. (1999) who also found that if strict aseptic techniques were adhered too during dressing changes, in addition to close monitoring of patients there was a decrease in bloodstream infection rates.
As described above CLABSIs are more common when aseptic techniques at the time of insertion have not been observed. Contamination of catheters by skin flora at the time of insertion is one of the risks for developing a subsequent CLABSI. Therefore CVCs need to be replaced within 48hrs if asepsis cannot be guaranteed for insertion (LeMaster et al., 2010).
For insertion and during care of a CVC the skin should be cleaned with an antiseptic solution. Research has found that 2% Chlorhexidine in 70% alcohol is more effective at killing microorganisms than a range of other commonly used antiseptics (Suwanpimolkul, Pongkumpai, & Suankratay, 2008).
Oliver Mimoz et al. (1996) evaluated a 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzyl alcohol solution with 10% povidone iodine solution for the insertion and care of intravascular catheter insertion sites and found lower rates of CLABSIs associated with the chlorhexidine preparation. This research was followed up in 2007 when Olivier Mimoz et al. (2007) again compared 5% povidone-iodine in 70% ethanol with a 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzyl alcohol solution, and found that the chlorhexidine preparation was associated with a 50% decrease in the incidences of catheter colonization and lower rates of CLABIs. They recommend chlorhexidine-based solutions replace povidone-iodine solutions in practice to help prevent catheter-related infections.
Oliver Mimoz et al. (1996); (2007) support the use of chlorhexidine as skin preparation but research in the area has not all had the same outcome. Humar et al. (2000) compared 0.5% tincture of chlorhexidine with 10% povidone iodine and found no difference in catheter colonization or CLABSIs.
Patients in the ICU are traditionally there for a number of days and personal hygiene needs addressed, as discussed intrinsic and extrinsic flora contribute to CLABSIs. When patients were bathed in a 2% chlorhexidine solution on a daily basis, it...