Central Line Care and Management

Catheter exit site infection

Mepore or gauze dressing should be used if the exit site is infected, and pus is present. If pus is visible on the outside of the dressing it should be changed daily otherwise it can be left in situ for 48 hours. If the dressing has been disturbed it should be replaced with a clean dressing. Sodium chloride 0.9% or aqueous chlorhexidine 0.05% may be used if the site is cleaned daily as chlorhexidine is spirit will sting and daily use irritates the skin. Ensure that the catheter is firmly secured to prevent accidental dislodgement whilst the exit site is infected. Antibiotics may be necessary either orally (if not neutropenic) or IV (if neutropenic) to help clear the infection.

If the infection spreads to include the skin tunnel and tracts upwards the catheter may require removal if IV antibiotics are ineffective.

References

• Marschall J, Mermel D, Fakih M, Hadaway L, Kallen A, O’Grady N et al. Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. 2014; 35 (7): 753-771.
• CDC National and State Healthcare-Associated Infections Progress Report.
• National Healthcare Safety Network, Centers for Disease Control and Prevention. The National Healthcare Safety Network (NHSN) Manual: Patient Safety Component Protocol.
• Fridkin SK, Pear SM, Williamson TH, Galgiani JN, Jarvis WR. The role of understaffing in central venous catheter–associated bloodstream infections. Infect Control Hosp Epidemiol. 1996; 17(3):150–158.
• Lorente L, Henry C, Martin MM, Jimenez A, Mora ML. Central venous catheter–related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005; 9(6):631–635.
• Rey C, Alvarez F, De-La-Rua V, Concha A, Medina A, Diaz JJ et al. Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit. Intensive Care Med. 2011; 37(4):678–685.
• Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355:2725-32
• Rinke ML, Chen AR, Bundy DG, Colantuoni E, Fratino L, Drucis K et al. Implementation of a Central Line Maintenance Care Bundle in Hospitalized Pediatric Oncology Patients. Pediatrics Sep 2012.
• Choi SW, Chang L, Hanauer DA, Shaffer-Hartmann J, Teitelbaum D, Lewis I et al. Rapid Reduction of Central Line Infections in Hospitalized Pediatric Oncology PatientsThrough Simple Quality Improvement Methods. Pediatric blood & cancer. 2013; 60(2):262-269.
• Mermel LA, Allon M, Bouza E, Craven D, Flynn P, O´Grady N et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49(1): 1–45.
• O’Grady NP, Alexander M, Burns LA, Patchen E, Garland J, Heard S et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52(9):162–193
• Health Research and Education Trust.(October 2012), Eliminating CLABSI, A National Patient Safety Imperative – AHRQ.
• Blausen.com staff (2014). Medical gallery of Blausen medical.

Pages: 1 2 3