When to replace a long-term catheter?

When to Replace a Long-Term Catheter

Long-term catheters (tunneled CVCs, ports, and long-term urinary catheters) should NOT be routinely replaced at fixed intervals; replacement should be based solely on clinical indications including infection, malfunction, or obstruction. 1

Central Venous Catheters (CVCs)

Routine Replacement is NOT Recommended

• Do not routinely replace CVCs, PICCs, hemodialysis catheters, or pulmonary artery catheters to prevent catheter-related infections 1
• Scheduled replacement at fixed intervals (e.g., every 2-4 weeks) has no evidence base and should be avoided 1
• Do not remove CVCs or PICCs based on fever alone; use clinical judgment to assess for other infection sources 1

Mandatory Removal Indications for Long-Term CVCs

Remove the catheter immediately when any of the following are present:

• Tunnel infection or port abscess 1
• Severe sepsis or septic shock 1
• Bloodstream infection with specific organisms: S. aureus, P. aeruginosa, fungi, or mycobacteria 1
• Complicated infections: endocarditis, septic thrombophlebitis, or metastatic infections 1
• Persistent bacteremia/fungemia >72 hours despite appropriate antimicrobial therapy 1

Catheter Salvage May Be Attempted When:

• Uncomplicated catheter-related bloodstream infection (CRBSI) with organisms OTHER than S. aureus, P. aeruginosa, fungi, or mycobacteria 1
• No tunnel infection or port abscess present 1
• No signs of severe sepsis or metastatic infection 1
• Use antibiotic lock therapy plus systemic antibiotics for 2 weeks in salvage attempts 1

Hemodialysis Catheter-Specific Guidelines

• Always remove for CRBSI due to S. aureus, Pseudomonas species, or Candida species 1
• For other pathogens (coagulase-negative staphylococci, other gram-negative bacilli): may attempt salvage with antibiotics if symptoms resolve within 2-3 days and no metastatic infection exists 1
• Can exchange over guidewire if symptoms resolve and no alternative sites available, though this is not ideal 1

Long-Term Urinary Catheters

Replacement Timing

• Do NOT replace at routine fixed intervals (e.g., monthly changes are not evidence-based) 2
• Replace based on clinical indications only: 2
  • Catheter blockage or obstruction
  • Leakage around the catheter
  • Encrustation
  • Catheter-associated urinary tract infection (CA-UTI)

Special Circumstances

• If catheter has been in place ≥2 weeks at onset of CA-UTI and continued catheterization is necessary, replace the catheter to hasten symptom resolution and reduce subsequent infection risk 2
• For patients with repeated early blockage from encrustation, some experts suggest changing every 7-10 days, though this lacks clinical trial evidence 2

Key Pitfalls to Avoid

• Never use guidewire exchanges for suspected infected non-tunneled catheters 1
• Do not administer systemic antimicrobial prophylaxis routinely before insertion or during catheter use 1
• Avoid removing long-term catheters prematurely in patients with limited venous access (e.g., hemodialysis patients, short-gut syndrome) when salvage is appropriate 1
• Do not delay removal when dealing with S. aureus, Pseudomonas, or fungal infections—these require immediate catheter removal due to high risk of complications and mortality 1