Central venous catheters disrupt the integrity of the skin, making infection with bacteria or fungi possible. A central line–associated bloodstream infection (CLABSI) may spread to the bloodstream and cause hemodynamic changes and organ dysfunction, possibly leading to death.
It is estimated that 500 to 4,000 U.S. patients die annually from bloodstream infections. In addition, nosocomial bloodstream infections prolong hospitalization by an average of seven days. A bloodstream infection costs an estimated US$3,700 to US$29,000. There are no equivalent Canadian figures.
You can reduce CLABSIs with two bundles of key evidence-based steps.
Central line insertion bundle:
- Hand hygiene
- Maximal barrier precautions
- Chlorhexidine skin antisepsis
- Optimal catheter type and site selection
- Avoid the femoral vein in adults; subclavian preferred to minimize infection risk.
- Optimal catheter type and site selection in children is more complex, with the internal jugular vein or femoral vein most commonly used. Site preference in children needs to be individualized.
Central line care bundle:
- Daily review of line necessity, with prompt removal of unnecessary lines
- Aseptic lumen access
- Catheter site and tubing care