CENTRAL VENOUS CATHETER INFECTIONS - CONCEPTS AND CONTROVERSIES

Central venous catheters (CVCs) are widely used in critically ill pati ents in intensive care units. However, infectious complications are co mmon and may limit their utility. We critically review the literature to determine the impact of CVC design amd composition, insertion site selection, insertion procedures, care and removal of temporary CVCs on infectious complications. Relevant articles were identified and selec ted for review using a database search (Medline and manual of the Engl ish language literature) based upon study design and sample size with an emphasis on prospective randomized trials. To minimize infectious c omplications and maintain a reasonable cost-benefit ratio, we recommen d: i) use a single lumen catheter unless clear indications for a multi -lumen catheter exist; ii) insert the catheter via the subclavian vein if no relative contraindication exists (bleeding diathesis, positive pressure ventilation); iii) disinfect the insertion site employing ste rile technique; iv) apply a dry, sterile dressing and change the dress ing every other day; v) inspect the insertion site for signs of infect ion and remove the catheter if pus is present; vi) if a catheter-relat ed infection is suspected, change the catheter over a guidewire and cu lture the distal segment. The replacement catheter should be removed i f an original catheter segment culture is positive.