Introduction

In the past central venous catheters (CVCs) were used almost exclusively in specialist areas such as Critical Care and Oncology. However with the new catheter designs, simpler and safer insertion techniques CVCs are now used throughout the Trust.

Bloodstream infections associated with the insertion and maintenance of CVCs are potentially among the most dangerous complications of healthcare that can occur, worsening the severity of the patients underlying ill health, prolonging the period of hospitalisation and increasing the cost of care. Almost 64% of patients in the UK with an intravascular device acquire a catheter related bloodstream infection (CR-BSI) (EPIC 3, 2013).

 

Purpose

The number of patients requiring central venous access continues to grow as the management of disease and trauma improves and life expectancy is prolonged. CVCs are lifelines for many patients in a wide array of circumstances, so establishing and maintaining safe, appropriate and reliable central venous access and care for this group of patients is vital. This policy outlines measures that will be implemented to reduce the risk of infection in any adult with a CVC.

 

Background

CR-BSI involves the presence of systemic infection and evidence implicating the CVC as its source, i.e. the same micro-organism from blood cultures as that shown to be significantly colonising the CVC of a patient with clinical features of a bacteraemia.

The micro-organisms that colonise catheter hubs and the skin adjacent to the insertion site are the source of most CR-BSI. Coagulase negative Staphylococci particularly Staphylococcus epidemidis also Staphylococcus aureus, candida species and Enterococci are the most commonly found organisms.

These organisms can be found on the patient’s skin and can contaminate the catheter during insertion, or migrate along the catheter track.

Contaminated fluids and equipment can lead to cross infection along with colonised hands of healthcare workers are factors that can be implicated in catheter related infection.

Central venous catheters (CVC) are long flexible catheters with single or multiple (2-5) lumens that enter central veins. These catheters are generally inserted into the jugular, subclavian and less frequently the femoral veins. CVC allow for administration of fluids, medication, nutrition and/or haemodynamic monitoring of critically ill patients.

Larger calibre CVCs may also be dedicated for encardial pacing wires, cardiac output monitoring techniques and continuous renal replacement therapy.

 

Policy Details

Download: PDF version
Compiled by: Infection Control Team
Ratified by: Clinical Governance Committee
Date Ratified: March 2018
Date Issued: April 2018
Review Date: March 2020
Target Audience: Healthcare professionals involved in CVC care
Contact name: Ann Birler