Types & Indications
Non-tunneled (ICU): IJ, subclavian, femoral. Tunneled (long-term): Hickman, Broviac. PICC: basilic vein to SVC. Port: implanted, accessed with Huber needle. Indications: TPN, chemo, long-term antibiotics, vasoactive drugs, monitoring, poor access, dialysis.
CLABSI Prevention
CLABSI mortality 12-25%. Prevention bundle: hand hygiene, max sterile barrier (cap, mask, gown, gloves, full drape), CHG skin prep (>2%), optimal site (subclavian > jugular > femoral), daily review of necessity, remove ASAP. Daily CHG bathing. CHG-impregnated dressings. Scrub hub 15 sec with CHG before each access.
Care & Maintenance
Dressing: transparent (q7 days) or gauze (q48h). Assess: redness, drainage, pain, swelling, migration. Flush: 10 mL NS before/after each use (positive pressure, positive displacement cap). Blood draws: discard 5-10 mL. Label all lines. Remove non-tunneled ASAP (5-7 days). Monitor for CLABSI (fever, chills, positive cultures).
Important Notes
- Scrub the hub for at least 15 seconds with chlorhexidine before every access — most important CLABSI prevention measure.
- Daily review of central line necessity and prompt removal when no longer needed is essential for CLABSI prevention.
Clinical Tips
- Use subclavian for non-tunneled CVCs when possible — lowest infection risk.
- Positive-pressure flushing prevents blood reflux and clotting — clamp after last 1 mL is flushed.
Summary
Central line care requires the CLABSI prevention bundle and meticulous hub care and dressing management.
