CDC Updates IV Catheter Infection Prevention Guidelines. Which Fluids and how much fluids to use Refer to the Intravenous Fluids Clinical Practice Guideline: Intravenous Fluids. New IV Guidelines: What's Most Critical to Know - Infection Control Today By Rita McCormick, RN, CIC and Laura Rutledge, RN, MN, CRNI. Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. 2012;380:1066-1074. Prior to injecting medications or administering IV fluids, patency is assessed by aspirating for blood return and flushing the PIVC with a 0.9% sodium chloride solution in a 10-mL syringe using a pushpause technique.29 If the PIVC cannot be flushed, it should be promptly removed. 2. http://www.cdc.gov/hicpac/BSI/references-BSI-guidelines-2011.html. However, measures were taken to minimize the potential for bias. Simin D, et al. Implementing Clinical Practice Guidelines for Replacing Peripheral Do not submerge the catheter or catheter site in water. The technique can be used to localized vessels, fluids and air in many parts of the body. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 3. Peripheral Vascular Catheter-Related Infection: Dwelling on Dwell Time Peripheral intravenous cannula insertion and use in the emergency department: an intervention study. Ultrasound guidance should only be used by those fully trained in its technique. Vessel health and preservation should be on every clinician's mind. Expert Perspectives on Personal Protection Guidelines and Standardization Practices. The patient is afraid of needles and is not eager to have her catheter replaced every few days. The guidelines for choosing the appropriate PIV gauge are the same for children as for adults. Gledstone-Brown L, McHugh D. Review article: idle just-in-case peripheral intravenous cannulas in the emergency department: is something wrong. The cost per infection attributable to central venous catheters is estimated at $34,508 to $56,000. Intraosseous vascular access in critically ill adultsa review of the literature. A peripheral intravenous (PIV) tube is a short plastic tube placed into the vein to give medication or fluid. The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recently released updated intravascular catheter infection prevention guidelines that support efforts to eliminate catheter-related bloodstream infections (CRBSIs). Use clinical judgment regarding the appropriateness of removing the catheter if infection is evidenced elsewhere or if a noninfectious cause of fever is suspected. Rickard CM, Webster J, Wallis MC, et al. PDF IV 03 Intravenous Therapy-General Guidelines - Craig Hospital The Centers for Disease Control and Prevention (CDC)s 2011 guidelines state that it is not necessary to replace peripheral IV catheters in adults more than every 72 to 96 hours,3 but the CDC does not specify when the catheters should be replaced. Washington, DC: The National Academies Press; 2011. This study did not report on the daily maintenance protocols the investigators used for the peripheral IVs. Infection Control Today speaks with the CEO of Blue Water Biotech about how to get around antimicrobial resistance and why there may not be a need for more antibiotic creation. How common are indwelling devices in hospitalized adults? Selection of Catheters and Sites. Careers, Unable to load your collection due to an error. Safety in the ICU CDC Guidelines for catheter related infection prevention in ICU December 03, 2017 The burden of infection control is even greater in critically ill patients, as they are naturally weakened by their state of health. Guidelines Library | Infection Control | CDC Another effective strategy is to conduct regular (every three to six months) local clinical surveillance audits to identify the extent of idle catheters and PIVC complications. 7. Shekelle P, Woolf S, Grimshaw JM, Schnemann HJ, Eccles MP. Showering should be permitted if precautions can be taken to reduce the likelihood of introducing organisms into the catheter (e.g., if the catheter and connecting device are protected with an impermeable cover during the shower) [9092]. to maintaining your privacy and will not share your personal information without The study summarized here addressed these concerns. Ruiz-Giardin JM, et al. Gurses AP, Marsteller JA, Ozok AA, Xiao Y, Owens S, Pronovost PJ. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the . Based on patient assessment and prescribed therapy, alternative methods can be used when a PIVC is not the appropriate device. The just in case PIVC must no longer be accepted practice. 23. Best practice also includes collecting and . Clinicallyindicated replacement versus routine replacement of 8. You may search for similar articles that contain these same keywords or you may * Use povidone iodine antiseptic ointment or bacitracin/ gramicidin/polymyxin B ointment at the hemodialysis catheter exit site after catheter insertion and at the end of each dialysis session only if this ointment does not interact with the material of the hemodialysis catheter per manufacturers recommendation [59, 115119]. Investigators have found that often the infections came from the patients themselves. Wear either clean or sterile gloves when changing the dressing on intravascular catheters. It'ssimply a matter of switching from a brown to a clear antiseptic. Wells C, et al. 49. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. The three most common pathogens causing CRBSI are coagulase negative staphylococcus, MRSA and Staphylococcus aureus. That said, we think that this is a worthwhile change to achieve the long-term benefits of fewer unnecessary IV catheter replacements. Use a guidewire exchange to replace a malfunctioning non-tunneled catheter if no evidence of infection is present. No recommendation can be made regarding the frequency for replacing intermittently used administration sets. Accessibility A PIVC is likely to be suitable for the patient who requires IV medications or fluids for four or fewer days; if medications are required for five to 14 days, an alternative device such as a midline catheter is preferable; and if irritant or vesicant infusates are prescribed, central venous access is a more appropriate choice.29 Evidence-based tools available on smart phone apps, such as the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC)30 or the miniMAGIC for pediatric patients,31 can guide appropriate device selection. Gauze and opaque dressings should not be removed if the patient has no clinical signs of infection. Ultrasound is an invaluable technology for the radiologist and other invasive physicians. 42. Fragmentation of care threatens patient safety in peripheral vascular, 16. Nurses managed 469 inpatients, receiving 1033 PIVCs. Guidelines Selected guidelines from agencies and professional associations related to infection prevention and control. 22. Collecting Blood from Patients with Vascular Lines | AACC.org 52. Evison H, et al. National Library of Medicine Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011). Some error has occurred while processing your request. An idle catheter is defined as a device in situ over 24 hours without a clear purpose (see What Defines an Idle PIVC?9).9 An integrative review of 13 studies with a total of 38,940 patients found that up to 50% of PIVCs remained idle after insertion in case they might be needed, despite no prescribed orders for IV medications, solutions, blood products, or planned procedures.10, Multiple studies have confirmed that idle catheters are a problem. Effectiveness of insertion and maintenance bundles in preventing. One patient in the routine placement group had a catheter-related bloodstream infection; no one in the clinically indicated group did. Clinical Practice Guidelines We Can Trust. The Centers for Disease Control and Prevention (CDC) recently published newguidelines for preventing IV-related infections. Implementing clinically indicated replacement of IVs could decrease hospital costs and improve patient satisfaction. Before No comparison has been made between using chlorhexidine preparations with alcohol and povidone-iodine in alcohol to prepare clean skin. Professional Development, Leadership and Scholarship, Professional Partners Supporting Diverse Family Caregivers Across Settings, Supporting Family Caregivers: No Longer Home Alone, Nurse Faculty Scholars / AJN Mentored Writing Award. Ullman AJ, et al. 8. Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR). Guidelines for the Prevention of Intravascular Catheter-related Disinfection and sterilization. With IV catheter use on therise, harder-to-treat pathogens making their way into patient bloodstreams andthe substantial cost of treating catheter-related bloodstream infections (CRBSI),these new guidelines serve as a reminder that we can never become complacentabout IV infection control. Centers for Disease Control and Prevention. Jon Wilson, a 20-year-old man, previously healthy and with no premorbid conditions, is admitted for a routine tonsillectomy and adenoidectomy. Catheters Used for Venous and Arterial Access, Epidemiology and Microbiology in Adult and Pediatric Patients, Strategies for Prevention of Catheter-Related Infections in Adult and Pediatric Patients, U.S. Department of Health & Human Services. Antiseptics should be allowed to dry according to the manufacturers recommendation prior to placing the catheter [82, 83]. In children, the brachial site should not be used. In the past, we have routinely replaced peripheral IV catheters every 48-72hours. Individuals whose IV catheters had been placed in an emergency were excluded, as were those who had a known bloodstream infection or who were not expected to have the IV in place for at least 24 hours. How can facilities help prevent these infections? Rickard CM, et al. The https:// ensures that you are connecting to the 21. A quality improvement project in an Australian ED requested staff to critically consider alternatives (such as oral medications or to wait for blood results) and only cannulate if they were 80% sure a hemodynamically stable patient would require a PIVC within the next 24 hours.32 This example of deliberate clinical inertia33 resulted in a reduction of PIVC insertions by 9.8%, and a cost savings of about $23 for each cannulation prevented.32, The INS Standards recommend prompt removal of the PIVC when it is no longer needed, if any complications develop, or within 24 to 48 hours if it was inserted under suboptimal aseptic conditions (emergent).29, In the acute care inpatient setting, the ongoing need for a PIVC should be reviewed daily with the patient's health care team. Change the needleless components at least as frequently as the administration set. Not just an intravenous line: consumer perspectives on peripheral intravenous cannulation (PIVC): an international cross-sectional survey of 25 countries. CDC Updates IV Catheter Infection Prevention Guidelines - Medscape Wolters Kluwer Health Of note, duration of dwell time is not an indication for PIVC removal because there is no known optimal dwell time.29 A Cochrane systematic review found no clear difference in the rate of phlebitis or bloodstream infection with routine PIVC replacement every 72 to 96 hours compared with replacement as clinically indicated (no longer needed or complications at the insertion site).36 In addition, several studies have reported cost savings ($2,100 per month,37 $7,263.60 per unit per month,38 and $17,100 per year39), as well as no increase in complications or infections, from the reduction in catheter supplies and staff cannulation time after removing PIVCs when clinically indicated rather than routinely. The study was conducted in hospitals in Australia, and we dont know whether the protocols used in that country are similar to standard protocols in US hospitals. Cochrane Database Syst Rev. Careers. No recommendation can be made about the use of chlorhexidine-impregnated dressings to protect the site of short-term, non-tunneled central venous catheters for pediatric patients less than 18 years old and non-premature neonates due to the lack of sufficient evidence from published, high-quality studies about efficacy and safety in this age group. In one U.S. study, a dedicated vascular access service of nurses trained to review the need for IV therapy prior to device placement determined that 35% of patients did not require vascular access.28, The need for clinical expertise and documented competency cannot be overstated. Avoid using the femoral vein for central venous access in adult patients [38, 50, 51, 54]. sharing sensitive information, make sure youre on a federal Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: a multicenter study. No local infections or IV-related bloodstream infections occurred in either group.5, A 2010 Cochrane review included 5 randomized controlled trials (with a total of 3408 patients) that compared rates of suspected catheter-related phlebitis in patients whose catheters were routinely replaced with those in the clinically indicated group. An official website of the United States government. Intravenous therapy: a review of, 46. Replacing a peripheral venous catheter when clinically - Cochrane Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Castro-Snchez E, et al. These include allowing for continuous visualinspection of the catheter site, permitting patients to bathe and shower withoutsaturating the dressing, and requiring less frequent changes than standard gauzeand tape -- saving healthcare personnel time. The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. Bethesda, MD 20894, Web Policies In the operating room, the anesthesiologist inserts a 22-gauge peripheral intravenous catheter (PIVC) into the back of Mr. Wilson's left hand for administering sedation, then an 18-gauge PIVC into his right antecubital fossa in case a blood transfusion is needed. In the routine group, catheters were replaced every 72 to 96 hours. Results: Routine PIVC replacement declined from 34% to 3% (P < .001). * 3. Authors: News Author: Laurie Barclay, MD The nurse reports that the patient already has a PIVC in his right antecubital fossa. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). (CDC) guidelines state that, "no recommendation is made regarding replacement of peripheral catheters in adults only when clinically indicated" (p. 15, O'Grady 2011). PERIPHERAL INTRAVENOUS CATHETER DWELL TIME AND PATENCY MAINTENANCE. For arterial peripheral tubing, the new CDC guidelines recommend extending the replacement interval from 72 hours to 96 hours, unless infection is suspected. Ensure that the PIVC is still necessary for treatment, still functioning, still tolerated by the patient, and still free from signs of complications or infection. 41. Saving Lives, Protecting People, Antimicrobial/antiseptic impregnated catheters and cuffs, Antibiotic lock prophylaxis, antimicrobial catheter flush and catheter lock prophylaxis, Replacement of peripheral and midline catheters, Replacement of CVCs, including PICCs and hemodialysis catheters, Peripheral arterial catheters and pressure monitoring devices, Needleless intravascular catheter systems, Implementation Considerations for Patients Aged 18 Years and Older, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), Intravascular catheter-related infection (BSI), Implementation Considerations for Patients aged 18 Years and Older, Table 1. PDF CHOC Children's Hospital Best Evidence and Recommendations Ray-Barruel G. I-DECIDEDa decision tool for assessment and management of invasive devices in the hospital setting. IV Fluid Considerations via Peripheral IV line. 30. The reviewers found no significant increase in phlebitis in the clinically indicated group (9%) vs the routine replacement group (7.2%) (odds ratio=1.24; 95% CI, 0.97-1.60; P=.09).6.