Central Venous Catheter Management

Preparation and Insertion

• The American Society of Clinical Oncology recommends using maximal barrier precautions, including a sterile cap, mask, gown, gloves, and full-body drape, to reduce the risk of catheter-related infections 1
• Use chlorhexidine-alcohol solution (minimum 2% CHG) for skin antisepsis and allow complete drying before puncture to reduce the risk of infection, as recommended by the International Journal of Infectious Diseases 2 and the American Society of Anesthesiologists 3
• Avoid the femoral site due to increased infection risk, with the internal jugular site being the preferred site for central venous catheter placement, as recommended by the American Society of Clinical Oncology 1 and the International Journal of Infectious Diseases 2
• Use real-time ultrasound guidance for vessel localization and venipuncture, and select thin-wall needle or catheter-over-needle technique based on clinical situation and operator experience, as recommended by the American Society of Anesthesiologists (ASA) 3
• Position the patient in the Trendelenburg position for neck/chest access when clinically appropriate to facilitate catheter placement, as recommended by the American Society of Anesthesiologists (ASA) 3
• Gather standardized equipment set, including ultrasound machine with sterile probe cover, central line kit with appropriate catheter size, sterile supplies for maximal barrier precautions, and chlorhexidine-containing antiseptic solution (>0.5%), as suggested by the American Society of Anesthesiologists (ASA) 3
• Select the smallest size catheter appropriate for the clinical situation, with the minimum number of lumens needed, as recommended by the American Cancer Society 4

Maintenance and Care

• Apply a sterile, transparent dressing over the insertion site to protect the catheter and reduce the risk of infection, as recommended by the American Cancer Society 4
• Replace the dressing no more than once weekly unless soiled or loose to maintain asepsis, as recommended by the American Cancer Society 4
• Clean catheter access ports with appropriate antiseptic before each access to reduce the risk of infection, as recommended by the American Society of Anesthesiologists (ASA) 3
• Cap stopcocks or access ports when not in use to prevent contamination, as recommended by the American Society of Anesthesiologists (ASA) 3
• Replace administration sets at least every 7 days (24 hours after blood products) to reduce the risk of infection, as recommended by the American Cancer Society 4
• Perform daily assessment of catheter necessity to ensure that the catheter is still required, as recommended by the American Cancer Society 4
• Maintain catheter patency through routine flushing with saline after completion of any infusion or blood sampling, with a maintenance schedule of four-weekly flush for subcutaneous ports and weekly flush for tunneled/PICC lines, as recommended by the American Society of Clinical Oncology 1, 5

Complications and Removal

• Catheter-related bloodstream infection (CRBSI), venous thrombosis, and catheter occlusion are potential delayed complications of central venous catheter placement, with catheter removal indicated in cases of tunnel infection, septic shock, or fungal infection, as recommended by the American Society of Clinical Oncology 1, 5
• Monitor for signs of infection and remove the catheter if central line-associated bloodstream infection (CLABSI) is suspected, as recommended by the International Journal of Infectious Diseases 2 and the American Cancer Society 4
• Conduct surveillance of central line-associated bloodstream infections to identify areas for improvement, as recommended by the International Journal of Infectious Diseases 2
• Verify final position with chest X-ray, especially when using the subclavian approach, as recommended by the International Journal of Infectious Diseases 5
• The following table summarizes the recommended insertion sites and their associated risks:

Education and Training

• Ensure proper education and training for all personnel involved in central venous catheter placement, as recommended by the American College of Radiology 6
• Provide education and competency assessment for all healthcare providers involved in central venous catheter placement and maintenance to ensure that they have the necessary skills and knowledge, as recommended by the International Journal of Infectious Diseases 2
• Implement a bundle approach for insertion and maintenance, including the use of checklists and protocols, to reduce the risk of complications, as recommended by the American Cancer Society 4 and the American Society of Anesthesiologists (ASA) 3