Review Question - QID 217078

This patient undergoing a central venous catheter (CVC) placement is at risk of central line associated bloodstream infection (CLABSI). In order to minimize the risk of CLABSI, skin antisepsis with a chlorhexidine and alcohol solution should be performed prior to draping the patient.

Numerous complications are associated with CVC placement, including pneumothorax, air embolism, catheter embolization, and infection. Sterile technique and skin antisepsis are crucial to decrease the risk of CLABSI. Sterile technique includes using adequately sized sterile drapes, proper hand hygiene with surgical antiseptic hand wash, long-sleeved sterile gowns, surgical masks, sterile gloves, and head coverings. The catheter insertion site should be disinfected with a chlorhexidine-alcohol solution (or a less effective alcohol-based iodine solution if the patient is allergic to chlorhexidine).

Mimoz and co-authors compared the risk of catheter-related infections in 2349 patients across 11 intensive care units randomized to receive chlorhexidine-alcohol or povidone iodine-alcohol antisepsis prior to catheter insertion. The investigators found a significantly lower risk of catheter-related infection with chlorhexidine-alcohol (0.28 vs 1.77 per 1000 catheter-days).

Incorrect Answers:
Answer 1: Flushing the central venous catheter with heparin is not routinely performed. Flushing the CVC is only considered in patients who require long-term access to prevent clotting.

Answer 2: Placing the central venous catheter in the femoral vein has been associated with a similar risk of CLABSI as placement in the internal jugular vein and a higher risk than placement in the subclavian vein. Placement of the CVC in the subclavian vein minimizes the risk of infection.

Answer 4: Replacing the central venous catheter every week does not reduce the risk of CLABSI and exposes the patient to unnecessary additional procedures. However, CVCs should be removed as soon as possible to reduce the risk of CLABSI.

Answer 5: Systemic antibiotic prophylaxis during central venous catheter placement is not standard practice. Studies have not demonstrated that periprocedural antibiotic prophylaxis during CVC placement decreases the risk of CLABSI.

Bullet Summary:
Central line associated bloodstream infections can be prevented with hand hygiene, appropriate personal protective equipment, preparation of the skin with alcohol and chlorhexidine, and removal of the catheter when no longer needed.