Central Line Maintenance
Royal Hospital for Sick Children
PICU
Central Line Maintenance
Author: Christina Harry
Lesley
Macfarlane,
Spenceley
Date of Review:
Neil
Version:
Authorised by:
Q-Pulse Ref:
Page 1 of 7
Issue Date:
Contents
1.
2.
3.
4.
5.
6.
7.
Background
Appropriate hand hygiene
Central line dressings
Use of smartsites
Transducer sets
Review
References
Page Number(s)
2
3
4
4
5
6
6
1. Rationale


To provide a standardised care pathway for maintenance of
central lines.
To provide educational material about the importance of
reducing catheter-related bloodstream infections as part of
our patient safety program.
2. Scope


This guideline applies to the maintenance of all central lines in
the paediatric intensive care unit.
To be used in conjunction with the hospital guideline for
central lines1.
3. Roles & Responsibilities

All healthcare professionals involved in the care of patients
with central lines should be aware of this guideline.
4. Evidence

This guideline has been constructed after consultation with
standard text books, a pubmed search (cather-related
bloodstream infections, antisepsis, Chloraprep©, pressure
transducers and infection), Scottish Patient Safety Program2
and local expert opinion.
1. Background
Intravascular catheters are an essential part of modern intensive care
practice. Unfortunately their use exposes patients to a number of
infectious complications, especially nosocomial bacteraemia3.
Central Line Maintenance
Author: Christina Harry
Lesley
Macfarlane,
Spenceley
Date of Review:
Neil
Version:
Authorised by:
Q-Pulse Ref:
Page 2 of 7
Issue Date:
Catheter-related bloodstream infections (CR-BSI) have a significant
impact on patient morbidity, mortality and healthcare costs4. One of the
main patient safety initiatives in intensive care medicine is reduction of
CR-BSI. There are a number of ways in which we can reduce the CR-BSI
incidence:
1. Standardised insertion technique, focusing on the ‘Central Line
Bundle.’ This is covered in the ‘Central Line Insertion’ guideline and
focuses on appropriate antisepsis and preparation and an insertion
checklist to empower staff to stop the procedure if the sterile
insertion technique is not followed correctly.
2. Standardised practice for central line maintenance, as outlined in
this guideline.
3. Daily review of the need for central access and removing
unnecessary lines as soon as possible to minimise the risk of
infection.
‘Central line maintenance’ is an essential part of reducing CR-BSI. A
study by Miller at al. specified that the main driver for additional
reductions in paediatric CR-BSI relate to a ‘maintenance bundle.5’ Even
with a careful and aseptic insertion technique, the central line provides
a route of entry for bacteria. Contamination of central lines may occur
by the following6:
o Skin organisms at the insertion site enter the cutaneous tract
along the surface of the central line with colonisation of the
tip – this is the most common
o Direct contamination by contact with contaminated hands,
fluids or devices
o Haematogenously seeding from other sites – less common
o Contamination of infusate - rare
Subsequent infections may be difficult to treat, may cause
deterioration of an already unstable patient and may necessitate
removal of the intravascular catheter7. Maintenance of the central line
is as important as the insertion in regards to minimising CR-BSI. This
guideline focuses on the following:
 Appropriate hand hygiene as per NHS GG&C hand hygiene
guideline8 and sterile gloves of the staff member accessing
the central line
 Close attention to central line dressings
 Use of SmartSites© on central lines
 Use of ChloraPrep© and Clinell© for antisepsis
 Changing of transducer sets every 72 hours
In addition, the need for the central access should be reviewed on a daily
basis at the ward round and removed if deemed appropriate.
Central Line Maintenance
Author: Christina Harry
Lesley
Macfarlane,
Spenceley
Date of Review:
Neil
Version:
Authorised by:
Q-Pulse Ref:
Page 3 of 7
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2. Appropriate Hand Hygiene
Close attention to hand hygiene and wearing sterile gloves before
handling or accessing central lines is vital. Clear guidance is given by
Infection Control guidelines (above the sinks on ICU) on the correct handwashing technique.
3. Central Line Dressings
Central line dressings should be clean, dry and secure. Dressings should
be routinely changed every 7 days, or earlier if soiled or non-adherent.
Dressings should be reviewed daily. When changing the dressing, the skin
should be cleaned with ChloraPrep© and labelled with the date changed.
Correct dressing
Incorrect dressing
4. Use of SmartSites©& Bionectors©
(refer to guideline)
SmartSites© or Bionectors © should be used on all ports, but not
between 3-way taps. They reduce infection rates in vascular access
devices by providing closure to the catheter hub.
Before accessing SmartSites© or Bionectors©, they should be cleaned
with Clinell© wipes (alcoholic 2% chlorhexidine) for 30 seconds and
allowed to dry for 30 seconds before use. The 30 second drying period
is essential as that is when bacterial killing occurs.
SmartSites© or Bionectors© on bolus ports should be changed on
Wednesday and Sunday. They are only licensed for 200 activations, so
to ensure that they are changed regularly, this will occur twice weekly.
SmartSites©/Bionectors© on infusion ports should be changed on
Sunday.
Central Line Maintenance
Author: Christina Harry
Lesley
Macfarlane,
Spenceley
Date of Review:
Neil
Version:
Authorised by:
Q-Pulse Ref:
Page 4 of 7
Issue Date:
5. Transducer Sets
Patients requiring transducer monitoring are more likely to be
colonised by nosocomial organisms and more vulnerable to infections3.
Reported outbreaks of nosocomial bacteraemia have been reported
from arterial infusions used for pressure monitoring from as early as
the 1960s6.
The following are important to reduce the risk of infection and are in
keeping with the CDC 2011 Guidelines for the Prevention of
Intravascular Catheter-Related Infections6:





Change every 72 hours, except intracardiac lines (PA and LA
lines).
Replace other components of the system at the time the
transducer is replaced
SmartSite© or Bionector© between Lectrocath and 3-way taps
(arterial and CVP).
Minimise the number of manipulations of and entries into the
pressure monitoring system.
Do not administer dextrose-containing solutions or parenteral
nutrition through pressure monitoring circuits.
Central Line Maintenance
Author: Christina Harry
Lesley
Macfarlane,
Spenceley
Date of Review:
Neil
Version:
Authorised by:
Q-Pulse Ref:
Page 5 of 7
Issue Date:
6. Review
This guideline should be reviewed every two years from the date of
approval.
Central Line Maintenance
Author: Christina Harry
Lesley
Macfarlane,
Spenceley
Date of Review:
Neil
Version:
Authorised by:
Q-Pulse Ref:
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7. References
1. http://www.clinicalguidelines.scot.nhs.uk/YOR-DIV008%20Central%20Venous%20Access%20devices%20March%202
012.pdf (Accessed April 2012)
2. http://www.staffnet.ggc.scot.nhs.uk/Corporate%20Services/Clinical
%20Governance/Key%20Information/Documents/SPSPP%20CVC%
20Insertion%20Bundle%20v0%201.doc (Accessed April 2012)
3. O’Grady N, Alexander M, Patchen Dellinger E, Gerberding JL, Heard
SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML,
Raad II, Randolph A, Weistein RA. ‘Guidelines for the Prevention of
Intravascular
Catheter
Related
Infections.’
Pediatrics.
2002;110;e51
4. Miller MR, Griswold
Rice TB, Ridling D,
‘Decreasing PICU
MACHRI’s Quality
125:206-13
M, Harris M, Yonokyan G, Huskins C, Moss M,
Campbell D, Margolis P, Muething S, Brilli R.
Catheter-Associated Bloodstream Infections:
Transformation Efforts.’ Pediatrics. 2010;
5. Miller MR, Griswold M, Harris II JM, Yenokyan G, Huskins WC, Moss
M, Rice TB, Ridling D, Campbell D, Margolis P, Muething S, Brilli RJ.
‘Decreasing PICU Catheter-Associated Bloodstream Infections:
NACHRI’s Quality Transformation Efforts.’ Pediatrics. 2010;
125(2):206-213
6. O’Grady NP, Alexander M, Burns LA, Dellinger P, Garland J, Heard
SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph
A, Rupp ME, Saint S, Healthcare Infection Control Practices
Advisory Committee. ‘Guidelines for the Prevention of Intravascular
Catheter-Related Infections, 2011.’ CDC, Department of Health &
Human Services USA, 2011.
7. Raad II, Hanna HA. ‘Intravascular Catheter-Related Infections New Horizons and Recent Advances.’ Archives of Internal Medicine.
2002; 162:871-8
8. http://library.nhsggc.org.uk/media_Assets/Infection%20Control/27
.09.11%20-%20Hand%20Hygiene%20v2.pdf (Accessed April 2012)
9. Mermel LA, Maki DG. ‘Epidemic Bloodstream Infections From
Haemodynamic Pressure Monitoring: Signs of the Times.’ Infection
Control & Hospital Epidemiology. 1989;10(2): 47-53
Central Line Maintenance
Author: Christina Harry
Lesley
Macfarlane,
Spenceley
Date of Review:
Neil
Version:
Authorised by:
Q-Pulse Ref:
Page 7 of 7
Issue Date: