Page 88 - policy and procedure infection control

Policies and Procedures on Infection Control

5.4.13.2 Selection of catheter insertion site
1. Weigh the risk and benefits of placing a device at a recommended site to
reduce infectious complications against the risk for mechanical complications
(e.g., pneumothorax, subclavian artery puncture, subclavian vein laceration,
subclavian vein stenosis, hemothorax, thrombosis, air embolism, and
catheter misplacement).
2. Use a subclavian site (rather than a jugular or a femoral site) in adult patients
to minimize infection risk for non-tunneled CVC placement.
3. Place catheters used for hemodialysis and pheresis in a jugular or femoral
vein rather than a subclavian vein to avoid venous stenosis if catheter access
is needed.

5.4.13.3 Maximal sterile barrier precautions during catheter insertion
1. Use aseptic technique including the use of a cap, mask, sterile gown, sterile
gloves, and a large sterile sheet, for the insertion of CVCs (including PICCS)
or guidewire exchange.

2. Use a sterile sleeve to protect pulmonary artery catheters during insertion.
5.4.13.4 Replacement of catheter
1. Do not routinely replace CVCs, PICCs, hemodialysis catheters, or pulmonary
artery catheters to prevent catheter-related infections.
2. Do not remove CVCs or PICCs on the basis of fever alone. Use clinical
judgment regarding the appropriateness of removing the catheter if infection
is evidenced elsewhere or if a noninfectious cause of fever is suspected.
3. Guidewire exchange:

• Do not use guidewire exchanges routinely for non-tunneled catheters to
prevent infection.
• Use a guidewire exchange to replace a malfunctioning non-tunneled
catheter if no evidence of infection is present.

• Use a new set of sterile gloves before handling the new catheter when
guidewire exchanges are performed.
5.4.13.5 Catheter and catheter-site care
1. General measures
Designate one port exclusively for hyperalimentation if a multilumen catheter
is used to administer parenteral nutrition.
2. Antibiotic lock solutions
Do not routinely use antibiotic lock solutions to prevent CRBSI. Use
prophylactic antibiotic lock solution only in special circumstances (e.g., in
treating a patient with a long-term cuffed or tunneled catheter or port with a
history of multiple CRBSIs despite optimal maximal adherence to aseptic
technique).

Ministry of Health Malaysia 77