Preventing Vascular Access Device (DIV) Infection Miguela A. Caniza Infectious Diseases Department St. Jude Children’s Research Hospital

IT’S VERY IMPORTANT!

Types of vascular access devices (VAD) and vascular catheters SHORT-TERM or TRANSITORY Peripheral vascular catheters - Venous - Arterial Central vascular catheters - Single-lumen - Multiple-lumen

Types of vascular access devices (VAD) and vascular catheters INTERMIDIATE-TERM Peripherally inserted central catheters (PICC)

Types of vascular access devices (VAD) and vascular catheters LONG-TERM or PERMANENT Central vascular catheters: a) WITH subcutaneous tract b) WITHOUT

Complications and/or problems of VAD Infection Blockage Dislocation Rupture

Complications and/or problems of VAD Pathogenesis of VAD infections: The most common source of pathogens:

Types of VAD infection A) Intraluminal colonization B) Superficial infection of the site of entry C) Vascular infection around the catheter (pericatheter) D) Bacteremia related to the VAD = Infectious microorganisms

Signs of infection Redness, chills, swelling, drainage, pain in the site of insertion and/or tract of Catheter, hypotension with tachycardia Pain Redness Chills

Strategies for the prevention of VAD infections

Strategies for the prevention of VAD infections 1 Types of VADs and insertion sites Location: - The location of the VAD shuold be based on the needs of the patient - Risk of infection: LOWER: single-lumen HIGHER: multiple-lumen

Strategies for the prevention of VAD infections 2 Barrier precautions - Before the insertion or manipulation of any catheter, do the following Hand Hygiene: Antiseptic detergent Chlorhexidine (2-4%) Waterless alcohol gel (>60%)

Strategies for the prevention of VAD infections 2 Barrier precautions - Before the insertion or manipulation of any catheter, do the following Gloves: Non sterile Sterile

Strategies for the prevention of VAD infections 2 Barrier precautions - Before the insertion or manipulation of any catheter, do the following For CVC insertion, use maximum barrier precautions: Long-sleeved sterile gowns Masks Caps Sterile drapes Sterile gloves

Strategies for the prevention of VAD infections 3 Intravenous teams - Professional team specializing in the insertion and care of VADs 4 Cutaneous antisepsis - Chlorhexidine 2% is preferable - Povidone-iodine 10% or - Alcohol 70% can be used

Strategies for the prevention of VAD infections 5 Care of insertion site and maintenance of VAD Dressing and anchoring Topical antiseptic creams

Strategies for the prevention of VAD infections 5 Care of insertion site and maintenance of VAD Tubing system Replacement

Strategies for the prevention of VAD infections 6 Anticoagulants and thrombolytics - Professional team specializing in the insertion and care of VADs Use Heparin lock - When no infusion is being given - To prevent the formation of thrombus Heparin at 10 units/mL - Long-term VADs Heparin at 100 units/mL - Long-term, fully implanted VADs - Peripherally inserted central catheter (PICC)

Strategies for the prevention of VAD infections 7 Additional recommendations Peripheral VADs - Selection of the VAD: based on its use, duration, and experience of personnel - Selection of site of insertion of VAD: - Hands - Scalp (newborn) Upper extremities instead of the lower ones - Dorsum of the foot Adults Children

Strategies for the prevention of VAD infections 7 Additional recommendations Peripheral VADs - Management of VAD after insertion: No antibiotics on the site of insertion Evaluate the site of insertion Evaluate daily Avoid the usage of antibiotics

Strategies for the prevention of VAD infections 7 Additional recommendations Central VADs - Including PICC and pulmonary catheters Surveillance of VAD infections Educate personnel in charge of VAD insertion

Strategies for the prevention of VAD infections 7 Additional recommendations Central VADs - Including PICC and pulmonary catheters Aseptic technique Dressing change

Strategies for the prevention of VAD infections 7 Additional recommendations Arterial VADs and pressure-monitoring devices

Strategies for the prevention of VAD infections 7 Additional recommendations Umbilical VADs

References For more information, consult the following references: O’Grady N, et al. Guidelines for the Prevention of Intravascular Catheter Related Infections. MMWR (2002;51[RR10]:1-26. Online: www.shea-online.org/Assets/files/position_papers/hicpac_cather.pdf 2. Crnich CJ and Maki DG. Intravascular Device Infections. In: APIC. APIC Text of Infection Control and Epidemiology, ed 2, Washington, 2005, Association for Professionals in Infection Control, pp 24-1 to 24-26.