Vascular access device management

Vascular access devices include: intravascular devices inserted into peripheral veins, peripheral intravenous cannula (PIVC), peripheral arterial devices, central venous catheters and peripherally inserted central catheters (PICC lines). These devices allow the easy administration of fluids, blood products and medications; and can permit monitoring of haemodynamic function, dialysis and collecting of blood specimens.

Vascular access devices can provide the route for healthcare associated infection, in particular, local infection or blood stream infections. Blood stream infections are an important cause of mortality, morbidity and prolonged hospitalisation.

Risk of infection is increased with prolonged duration of peripheral intravascular catheters.

Prevention of healthcare associated infections related to invasive devices is a high priority patient safety issue covered under Standard 3 of the National Safety and Quality Health Service Standards.

Minimising the risk of vascular access device associated infection

Key recommendations

• ensure that the vascular access device is absolutely necessary for the patient
• remove the vascular access device as soon as it is no longer needed, or if complications from the device occur.

Insertion

Insertion of a vascular access device should only be undertaken by persons trained and competent in the technique.

Key points are:

• use aseptic technique when inserting all vascular devices
• central venous catheters (including PICC lines) should be inserted using maximum barrier precautions
• decontaminate the insertion site using an appropriate skin disinfectant such as alcohol-based preparations containing 70% isopropyl alcohol v/v and at least 0.5% chlorhexidine. Allow to dry prior to insertion
• in most circumstances, chlorhexidine-impregnated sponge (central lines), and sterile gauze or transparent semi-transparent dressing, should be used to cover the insertion site
• document the patient’s records, insertion details and any complications.

Access

Key points are:

• perform hand hygiene and wear appropriate personal protective equipment (PPE) before accessing or manipulating vascular access devices
• decontaminate access ports with a 70% isopropyl alcohol wipe for at least 15 seconds using a reasonable amount of friction.

Maintenance

Key points are:

• inspect dressings daily
• change if soiled or loose, routinely after 7 days in children, and routinely after 8 days for tunnelled central venous devices
• routinely replace peripheral intravenous devices every 2-3 days (or sooner if clinically indicated), if access still required. However do not routinely replace other vascular access devices
• assess all devices daily and remove if no longer required or if complications occur
• document assessment, removal or complications in the patient’s records.

The SA Health Peripherally Inserted Central Catheter (PICC) Dressing Management Clinical Guideline (PDF 789KB) outlines the procedure for performing a dressing change for a peripherally inserted central catheter (PICC) that is secured with an adhesive securement device.

The SA Health Peripherally Intravenous Cannula (PIVC) Infection Prevention Clinical Directive (PDF 661KB) outlines best practice principles for the insertion and management of PIVC with a focus on infection prevention.

Further information

For further information on the management of indwelling devices, contact SA Health's Infection Control Service on (08) 7425 7161.