Insertion Related Infection Prevention with Vascular Access Devices

The goal for vascular access is to provide the best access device for the administration of therapies, according to the patient’s treatment plan, with the least risk of damage to the patient’s vascular system. One of the ways to preserve the patient’s vasculature is through prevention of infection associated with these devices. The central line bundle, as described by Peter Pronovost and colleagues in a landmark study known as the Keystone ICU project consists of five components that, when strictly adhered to during the insertion of a central line catheter, are known to reduce the risk of catheter-related bloodstream infection (CRBSI). The five components include hand hygiene, maximal barrier precautions during insertion, use of chlorhexidine for skin antisepsis, optimal catheter site selection with avoidance of the femoral vein for central venous access in adult patients, and daily review of line necessity with prompt removal of unnecessary lines. These five components to prevent infection during the insertion of a central catheter are reviewed in this chapter. Care and maintenance considerations, equally important in the prevention of infection, are covered in detail throughout the rest of this book.