ZOLL Thermogard XP IVTM Physician Manual - Manual (Page 29)

ZOLL IVTM™ System Physicians' Manual
600248-001 Rev 3 28
Infection
Catheter Related Bloodstream Infection (CR-BSI) are of concern with any catheter.
There is a significantly increased risk of CR-BSI [42] associated with:
• Inexperience of the operator and nurse-to-patient ratio in the intensive
care unit,
• Catheter insertion with less than maximal sterile barriers,
• Placement of a CVC in the internal jugular or femoral vein rather than
subclavian vein,
• Placement in an old site by guidewire exchange,
• Heavy colonization of the insertion site or contamination of a catheter
hub, and
• Duration of CVC placement > 7 days.
The US Center for Diseases Control has published Guidelines for the Prevention of
Intravascular Catheter-Related Infections[43]. The recommended preventive
strategies with the strongest supportive evidence are:
• Education and training of healthcare providers who insert and maintain
catheters;
• Maximal sterile barrier precautions during central venous catheter
insertion;
• Use of a 2% chlorhexidine preparation for skin antisepsis;
• No routine replacement of central venous catheters for prevention of
infection; and
• Use of antiseptic/antibiotic-impregnated short-term central venous
catheters if the rate of infection is high despite adherence to other
strategies (ie, education and training, maximal sterile barrier precautions,
and 2% chlorhexidine for skin antisepsis).
The same Guidelines make the following recommendations relating to the
replacement of catheters in relation to the management of catheter-related infection.