Central Line Awareness

A central venous catheter provides access to the central circulation through a catheter whose tip terminates in a large central vein or the cavoatrial region, depending on the device and indication. A PICC enters through a peripheral arm vein but is still a central line once its tip reaches central circulation. Tunneled catheters, implanted ports, non-tunneled catheters, and dialysis catheters differ in design, but they share the same central-line safety problem: a break in the access system can deliver organisms directly into the bloodstream. Central access is chosen for therapies that may irritate small peripheral veins or require reliable high-flow access, such as vesicant medication, parenteral nutrition, vasopressors, some prolonged antimicrobial regimens, haemodynamic monitoring, or dialysis. That benefit comes with risks of bloodstream infection, thrombosis, occlusion, malposition, bleeding, air embolism, and insertion-related injury. A central line-associated bloodstream infection (CLABSI) is a laboratory-confirmed bloodstream infection in a patient with a central venous catheter in place for more than 48 hours, when the infection is not attributable to another site, using the CDC/NHSN criteria adopted by CNISP. A fever alone does not...