Duration Guidelines for Catheter Placement
The maximum duration a catheter should remain in place depends on the catheter type and location, with noncuffed femoral catheters limited to 5 days and internal jugular catheters to 1 week to minimize infection risk.
Duration Guidelines by Catheter Type and Location
Noncuffed Catheters
- Femoral catheters should not remain in place longer than 5 days and should only be used in bed-bound patients with good exit-site care 1
- Internal jugular noncuffed catheters should not be used for more than 1 week due to increasing infection risk 1
- Beyond 1 week, infection rates increase exponentially for noncuffed catheters 1
Tunneled Cuffed Catheters
- Preferred for longer durations of hemodialysis therapy over noncuffed catheters due to lower infection rates 1
- Can remain in place for extended periods with proper care and monitoring 1
Umbilical Catheters
- Umbilical artery catheters should optimally not be left in place more than 5 days 1
- Umbilical venous catheters can be used up to 14 days if managed aseptically 1
Peripheral Venous Catheters
- In adults, replace short peripheral venous catheters at least every 72-96 hours to reduce phlebitis risk 1
- In pediatric patients, peripheral venous catheters can remain until IV therapy is completed unless complications occur 1
Infection Risk and Monitoring
Risk Factors for Catheter-Related Infections
- Duration of catheterization is the principal determinant of infection 2
- Infection rates for catheters are approximately 5% per day 2
- Noncuffed catheter infection rates are more than 5 times greater with internal jugular catheters and almost 7 times greater with femoral catheters compared to tunneled cuffed catheters 1
Monitoring Requirements
- Monitor for signs of exit site infection, tunnel tract infection, or systemic infection 1
- Any sign of infection should prompt removal of noncuffed catheters 1
- For tunneled cuffed catheters, exit site infections may be treated with antibiotics without immediate removal 1
Special Considerations
Catheter Location Selection
- Right internal jugular vein is preferred for catheter placement due to direct route to caval atrial junction and lower complication risk 1
- Avoid subclavian vein catheterization due to risk of central venous stenosis 1
- Femoral catheters should be at least 19 cm long to minimize recirculation 1
Catheter Management
- Nonfunctional noncuffed catheters can be exchanged over a guidewire or treated with urokinase if no infection is present 1
- Ultrasound-directed cannulation minimizes insertion complications and should be used when available 1
- Post-insertion chest x-ray is mandatory after internal jugular or subclavian insertion to confirm catheter tip position 1
Prevention Strategies
Reducing Infection Risk
- Maintain a closed drainage system 2, 3
- Remove catheters as soon as possible when no longer needed 1, 4
- Use tunneled cuffed catheters for anticipated longer durations of catheterization 1
- Consider alternative methods to indwelling catheters when possible, such as clean intermittent catheterization 5
Common Pitfalls to Avoid
- Leaving femoral catheters in place for more than 5 days in non-bed-bound patients 1
- Failing to monitor for signs of infection 1
- Discharging patients with noncuffed catheters due to risks of infection, inadvertent removal, and hemorrhage 1
- Using subclavian vein for catheter placement in patients who may need permanent vascular access 1