Central Line Placement and Management

Pre-Procedure Preparation

• The International Journal of Infectious Diseases recommends that all healthcare personnel involved in central line procedures undergo comprehensive education and competency assessment before performing these procedures 1, 2
• The Annals of Oncology suggests preparing all necessary equipment in advance and creating a sterile field 3, 4
• The International Journal of Infectious Diseases advises performing hand hygiene using either alcohol-based waterless product or soap and water before catheter insertion or manipulation 1, 2
• The International Journal of Infectious Diseases recommends implementing maximum sterile barrier precautions including mask, cap, sterile gown, sterile gloves, and large sterile drape covering the patient 1, 2

Site Selection

• The International Journal of Infectious Diseases and Annals of Oncology suggest avoiding the femoral site due to increased risk of infection and thrombosis, especially in ICU settings 1, 3
• The Annals of Oncology and Ca-A Cancer Journal for Clinicians recommend considering subclavian or internal jugular veins as preferred insertion sites 3, 5
• The International Journal of Infectious Diseases advises avoiding subclavian sites for patients requiring hemodialysis due to risk of stenosis 1

Insertion Procedure

• The International Journal of Infectious Diseases and Journal of the American College of Radiology recommend using ultrasound guidance for catheter insertion to reduce complications and improve success rates 1, 7
• The International Journal of Infectious Diseases suggests applying alcoholic chlorhexidine solution (minimum 2% CHG) to the insertion site and allowing it to dry completely before puncturing the skin 1, 2
• The Annals of Oncology recommends verifying catheter tip position using intraoperative fluoroscopy, post-operative chest X-ray, or intracavitary ECG method 3, 4

Post-Procedure Care

• The Annals of Oncology advises monitoring vital signs (temperature, pulse, blood pressure, respiratory rate) every 4 hours after the procedure 3, 4
• The Ca-A Cancer Journal for Clinicians and Journal of the American College of Radiology recommend placing a sterile, transparent dressing over the insertion site and replacing it no more than once weekly unless soiled or loose 5, 7
• The International Journal of Infectious Diseases suggests considering daily chlorhexidine bathing for ICU patients over two months of age to reduce infection risk 1, 2

Maintenance and Prevention of Complications

• The Annals of Oncology recommends performing routine flushing with saline after completion of any infusion or blood sampling 3, 4
• The Ca-A Cancer Journal for Clinicians advises replacing administration sets and needle-less connectors at least every 7 days (or within 24 hours after blood, blood products, or fat emulsion infusions) 5

Infection Prevention and Management

• The Ca-A Cancer Journal for Clinicians recommends implementing a bundle approach to reduce central line-associated bloodstream infections (CLABSI) 5
• The Annals of Oncology suggests collecting paired blood cultures from the catheter and a peripheral vein before starting antibiotics if CLABSI is suspected 3, 4

Quality Improvement Measures

• The Ca-A Cancer Journal for Clinicians recommends implementing collaborative performance-improvement initiatives with designated physician and nursing team leaders 5
• The Ca-A Cancer Journal for Clinicians advises using checklists to assess compliance with bundle elements 5
• The Ca-A Cancer Journal for Clinicians suggests empowering staff to stop procedures if protocols are not followed 5