From the Guidelines
For central line replacement after 15 days, guidewire exchange at the same site is generally not recommended as a routine practice, instead, insertion at a new site is preferred to reduce infection risk. Guidewire exchange should only be considered in specific situations where the benefits outweigh the risks, such as when a patient has limited venous access options or high bleeding risk. If you must use guidewire exchange, ensure strict aseptic technique with complete sterile barrier precautions. The concern with guidewire exchange is that bacteria colonizing the original catheter can be introduced into the bloodstream during the procedure. Central line-associated bloodstream infections (CLABSI) are serious complications with significant morbidity. However, there is no absolute requirement to change central lines at 15 days if there are no signs of infection or mechanical problems. Central lines can remain in place as long as they are functioning properly and show no signs of infection. Daily assessment of the insertion site for redness, swelling, or discharge is essential for all central lines. According to the guidelines 1, guidewire exchanges should not be used routinely for non-tunneled catheters to prevent infection, and should only be used to replace a malfunctioning non-tunneled catheter if no evidence of infection is present.
Some key points to consider when deciding on guidewire exchange include:
- The presence of signs of infection, such as redness, swelling, or discharge at the insertion site
- The functionality of the central line, and whether it is still meeting the patient's needs
- The patient's overall health status, including the presence of any underlying medical conditions that may increase the risk of infection
- The availability of alternative venous access options, and the potential risks and benefits of using a new site versus guidewire exchange. Guidewire exchange was rated as appropriate when changes to existing PICC characteristics were desired, and when there are no signs of local or systemic infection 1.
From the Research
Central Line Replacement
After 15 days, replacing a central line is a crucial decision to prevent infections and ensure patient safety. The question arises whether guidewire exchange on the same site is sufficient or if a new site should be used for replacement.
Guidewire Exchange vs New Site Placement
- Studies have shown that guidewire exchange may increase the risk of infection, particularly in pediatric patients 2, 3.
- A systematic review of the literature found that guidewire exchange is associated with a trend toward a higher rate of catheter colonization and catheter-related bacteremia compared to new-site replacement 4.
- However, guidewire exchange may be associated with fewer mechanical complications than new-site replacement 4.
- A study on temporary dialysis catheter insertion in ICU patients found that guidewire exchange did not contribute to catheter colonization or infection but was associated with a higher rate of catheter dysfunction compared to new-site placement 5.
Considerations for Replacement
- The decision to use guidewire exchange or new-site placement should be based on individual patient factors, such as the presence of infection or mechanical complications.
- Meticulous aseptic technique is necessary when performing guidewire exchange to minimize the risk of infection 4.
- Regular evaluation of the need for the central line and proper maintenance and care can help reduce the risk of central line-associated bloodstream infections 6.