Preventing Central Line Infections - University of Minnesota Children's Hospital
 
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Preventing Central Line Infections

In the hospital, you may have a small, soft tube placed in a vein in your arm, neck, or chest. This is a central line (also called a venous catheter). It’s often used when medications or nutrition need to be given over a period of weeks or months. Having a central line means that you won’t need an IV (intravenous) line. But central lines can cause certain problems. One such problem is infection. This occurs when germs get into the catheter site or in your bloodstream. A bloodstream infection can make you very ill and can even be fatal. This sheet tells you more about central line infections, what hospitals are doing to prevent them, and how they are treated if they do occur.

Types of Central LinesCloseup of arm and part of chest. Heart and arm veins are visible. PICC line is inserted in arm at elbow and through vein into heart.

  • Peripherally inserted central catheter (PICC line): This line is placed in a large vein in the arm, near the bend in the elbow. It’s then threaded through the vein until the tip sits in the large vein just above the heart. It can also extend into the heart. A PICC line has a low risk of infection.

  • Subclavian line: This line is placed through the skin directly into the subclavian vein, which runs behind the collarbone. A subclavian line has a lower risk of infection than a jugular or femoral line.

  • Internal jugular line: This line is placed into the internal jugular vein (a large vein in the neck).

  • Femoral line: This line is placed in a large vein in the groin. A femoral line has a higher risk of infection but a lower risk of complications than other types of central lines.

  • Tunneled catheter: This catheter is tunneled through the soft tissue under the skin before it enters a vein. It also has a small cuff that helps hold the catheter in place. Both the tunnel and the cuff help prevent infection.

  • Port: This is a small device that is placed under the skin on the arm or chest. The port is connected to a catheter that runs through a large vein near the heart. Infections can develop inside the catheter or around the port.

What Causes Central Line Infections?

A central line is needed for your treatment. But a central line can also act as a pathway for germs into your body. Often, the germs that cause a central line infection come from your own skin.

What Are the Risk Factors for a Central Line Infection?

Anyone who has a central line can get an infection. The risk is higher if you:

  • Are in the intensive care unit.

  • Have a weakened immune system or serious illness.

  • Are receiving bone marrow or chemotherapy.

  • Have the line in for an extended time.

  • Have a central line in your neck or groin.

What Are the Symptoms of a Central Line Infection?

  • Redness, pain, or swelling at or near the catheter site

  • Pain or tenderness along the path of the catheter

  • Drainage from the skin around the catheter

  • Sudden fever and chills

How Are Central Line Infections Treated?

Treatment depends on the type of catheter, how severe the infection is, and your overall health. Your doctor will prescribe antibiotics to fight the infection. The line may also need to be removed. In some cases, the line is flushed with high doses of antibiotics. This may kill the germs causing the infection so that the line doesn’t have to be removed.

Preventing Central Line Infections: What Hospitals Are Doing

Hospitals have a plan to reduce line infections. The plan includes these five steps:

  • Handwashing: Hospital staff wash their hands before and after touching the line. They use soap and water or an alcohol-based hand cleaner containing at least 60 percent alcohol.

  • Sterile clothing and drapes: The healthcare worker who places the line wears sterile clothing. This includes a long-sleeved gown, mask, gloves, and hair covering. The patient is fully covered with a sterile drape (a large, sterile sheet) except for the spot where the line is placed.

  • Sterile skin: Before the line is placed, the patient’s skin is cleaned with an antiseptic solution.

  • Vein choice: Whenever possible, the line is placed in a vein that has a lower risk of infection. Some hospitals use lines coated with an antiseptic to reduce the chance of infection. The site where the line enters the body is covered with a sterile dressing.

  • Checking for infection: The line is checked every day for infection. It is removed as soon as it is no longer needed.

Preventing Central Line Infections: What Patients Can Do

  • Ask lots of questions. Find out why you need the line and where it will be placed. Learn what steps the hospital is taking to reduce the danger of infection.

  • Wash your own hands often. Use soap and water or an alcohol-based hand gel containing at least 60 percent alcohol.

  • Be sure doctors and nurses clean their hands with soap and water or an alcohol-based hand cleaner before and after checking your line. Don’t be afraid to remind them.

  • Try not to touch your line or dressing.

How Family and Friends Can Help

In the hospital:

  • Wash your hands well before and after visiting the patient.

  • Be sure doctors and nurses wash their hands before and after checking the patient’s line. They should use soap and water or an alcohol-based hand cleaner. Don’t be afraid to speak up if you don’t see proper handwashing.

  • Try not to touch the line or dressing.

At home:

  • Learn sterile dressing technique if you will be caring for the line at home. The doctor or nurse can show you how.

Tips for Good Handwashing

  • Use warm water and plenty of soap. Work up a good lather.

  • Clean the whole hand, under your nails, between your fingers, and up the wrists.

  • Wash for at least 15 seconds. Don’t just wipe. Scrub well.

  • Rinse, letting the water run down your fingers, not up your wrists.

  • Dry your hands well. Use a paper towel to turn off the faucet and open the door.

Using Alcohol-Based Hand Gels

Alcohol-based hand gels are also a good choice for cleaning your hands. Use them when you don’t have access to soap and water or your hands aren’t visibly dirty. Follow these steps:

  • Spread about a tablespoon of gel in the palm of one hand.

  • Rub your hands together briskly, cleaning the backs of your hands, the palms, between your fingers, and up the wrists.

  • Rub until the gel is gone and your hands are completely dry.

 

When to Call the Doctor

Call your doctor right away if you have a central line and develop any of the following:

  • Redness, swelling, warmth, or pain at the catheter site

  • Drainage, pus, or bleeding from the catheter site

  • Swelling under the skin at the catheter site

  • Fever of 100.4°F or higher, or shaking chills

  • Shortness of breath or chest pain

 

 

 
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