Infection

• Incidence of catheter related blood stream infections (CRBSI) is 1.1 per 1000 PICC-days outpatient setting
• 2.1 per 1000 PICC-days inpatient
• Infection rates are higher for PICCs placed in the antecubital fossa compared to those placed in the upper arm (i.e., basilic vein). Other factors that increase the risk of infection are those that are not tunneled and those with multiple lumens (Gonzalez 2021).

• Education and credentialing of staff providing PICC palcement and care.
• Hand hygiene with alcohol based or antiseptic soap for allcentral line care including before and after donning gloves
• Maximal sterile barrier precautions for central line insertion include: surgical gown, sterile gloves, mask, cap, and a large sterile sheet drape.
• >0.5% chlorhexidine with alcohol skin prep for central venous catheter and peripheral arterial catheter insertion and during dressing change - CDC 2011
• Avoid femoral and the antecubital fossa due to a a higher rate of CLABSI.
• Standardize the central venous catheter insertion procedure, utilizing dedicated insertion kit or cart, a catheter insertion checklist and a trained professional health care observer empowered to suspend the procedure until breaches in policy or sterile technique are corrected.
• Chlorhexidine impregnated sponge and semipermeable dressing are changed not earlier than 7 days unless soiled or moisture is visible. Chlorhexidine antiseptic skin prep applied and dried at dressing change.
• Change IV set no sooner than 96 hours. If blood/products, fat, amino acids or irritants are infused change within 24 hours. Change every 6-12 hours per manufacturer if propofol is infused.
• Change needleless connectors with IV sets. Cleanse connectors chlorhexidine or alcohol when accessed
• Prompt removal of PICC if alternative treatment delivery is acceptable.

Symptoms

• Fever 100.4 F and/or chills.
• Redness, swelling, tenderness, and/or drainage at the exit site.

Management

• Report and record the date of the first sign/symptom to begin Infection Window Period and Date of Event.
• Antibiotics.
• Staff and patient education
• Blood culture
• PICC not usually removed for fever alone

Central Line Associated Blood Stream Infection (CLABSI). CLABSI must meet each point of one of the following criteria:

Criteria 1

• A patient of any age has a recognised bacterial or fungal pathogen cultured from one or more blood cultures.
• The organism cultured from blood is not related to an infection at another site.

Criteria 2

• A patient of any age has at least one of the following signs or symptoms: fever (> 38°C), chills or hypotension, or
• A patient < 1 year of age has at least one of the following signs or symptoms: fever (> 38°C core), hypothermia (< 36°C core), apnoea or bradycardia.

Insertion site - bleeding or leaking

External catheter kinks, fracture or embolize during placement. Fractures of the internal portion of the catheter are also possible.

Intraluminal occlusion by substance accretion such as blood and fibrin build-up or medication precipitation

Phlebitis/Infiltration

The result of mechanical damage from the catheter itself or chemical irritation (medications). Phlebitis may occur within the first week after insertion. Removal of the catheter is not always necessary. If chemical irritation causes it, diluting medications or administering them at a lower rate can decrease inflammation.

Symptoms:

• Pain: Arm, shoulder, neck
• Distention arm and neck veins
• Edema: arm, shoulder, neck/face

Treatment

• warm compresses
• thrombolysis
• anticoagulant
• catheter removal