From the Guidelines
Central lines should not be routinely changed on a predetermined schedule, but rather only when clinically indicated, such as when there is evidence of catheter-related bloodstream infection, mechanical failure, or when the line is no longer needed. Current best practice recommends that central venous catheters remain in place as long as they are functioning properly and there are no signs of complications such as infection, occlusion, or displacement 1. Routine replacement of central lines does not reduce infection rates and actually increases the risk of mechanical complications from additional insertion procedures. Daily assessment of the insertion site for signs of infection (redness, swelling, discharge, tenderness) and evaluation of line necessity should be performed.
Key Considerations
- The catheter site dressing should be changed when soiled or loose, typically every 7 days for transparent dressings or every 2 days for gauze dressings 2.
- Central lines should only be replaced when clinically indicated, such as when there is evidence of catheter-related bloodstream infection, mechanical failure, or when the line is no longer needed.
- Guide wire assisted catheter exchange has a role in replacing a malfunctioning catheter, but is contraindicated in the presence of infection at the catheter site or proven CRBSI 1.
Best Practices
- Non-tunneled CVCs should not be removed and replaced routinely, and they should not be changed routinely over a guide wire 1.
- Prophylactic administration of systemic or local antibiotics before or during the use of a CVC is not recommended, since it does not reduce the incidence of CR-BSI 1.
- The intravenous catheter administration set should be changed every 24 h (when using lipid PN) or every 72 h (if lipids are not infused) 1.
From the Research
Central Line Replacement Guidelines
- There is no specific guideline on the exact number of days after which a central line should be changed, as the provided studies focus on the prevention and management of central line-associated bloodstream infections rather than the replacement schedule 3, 4, 5.
- The studies emphasize the importance of proper hand hygiene, dressing management, and catheter care to prevent infections 3, 4, 5.
- Antibiotic lock therapy has been shown to be effective in preventing catheter-related bloodstream infections in some studies 4, 6.
- The choice between peripherally inserted central catheters (PICCs) and midlines depends on the patient's specific needs and the duration of use, with midlines potentially having a lower risk of bloodstream infection and occlusion for short-term use 7.
Key Considerations
- Central line-associated bloodstream infections can occur in both intensive care and non-intensive care units 3.
- The use of antimicrobial lock therapy may be beneficial in preventing infections, but the quality of evidence varies 6.
- Regular evaluation of the need for the central line and proper maintenance are crucial to reducing the risk of infection 3, 5.