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

2. IT’S VERY IMPORTANT!

3. 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

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

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

6. Complications and/or problems of VAD
Infection
Blockage
Dislocation
Rupture

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

8. 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

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

10. Strategies for the prevention of VAD infections

11. 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

12. 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%)

13. 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

14. 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

15. 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

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

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

18. 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)

19. 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

20. 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

21. 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

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

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

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

25. 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:
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