This document discusses strategies for preventing infections of vascular access devices (VADs). It begins by describing different types of VADs, including short-term, intermediate-term, and long-term catheters. It then discusses potential complications of VADs like infection, blockage, and dislocation. The main strategies discussed for preventing VAD infections include using proper barrier precautions during insertion and maintenance, optimal insertion site selection, antiseptic skin cleansing, dressing care and maintenance, and surveillance of infections. Additional recommendations are provided for managing peripheral, central, arterial, and umbilical VADs.

1. Preventing
Vascular Access Device
(DIV) Infection
Miguela A. Caniza
Infectious Diseases Department
St. Jude Children’s Research Hospital

2. IT’S VERY IMPORTANT!

3. Types of vascular access devices
(VAD) and vascular catheters
SHORT-TERM or TRANSITORY
 Peripheral
vascular
catheters
- Venous
- Arterial
 Central vascular catheters
- Single-lumen
- Multiple-lumen

4. Types of vascular access devices
(VAD) and vascular catheters
INTERMIDIATE-TERM
 Peripherally
inserted central
catheters (PICC)

5. Types of vascular access devices
(VAD) and vascular catheters
LONG-TERM or PERMANENT
 Central vascular
catheters:
a) WITH
subcutaneous
tract
b) WITHOUT
subcutaneous
tract

6. Complications and/or problems of
VAD
Infection Blockage
Dislocation Rupture

7. Complications and/or problems of
VAD
Pathogenesis of VAD infections:
The most common source of pathogens:

8. Types of VAD infection
A) Intraluminal colonization
B) Superficial infection of the site of entry
C) Vascular infection around the catheter (pericatheter)
D) Bacteremia related to the VAD
= Infectious microorganisms

9. Signs of infection
Pain Redness Chills
Redness, chills, swelling, drainage, pain in
the site of insertion and/or tract of
Catheter, hypotension with tachycardia

10. Strategies for the prevention of VAD
infections

11. Strategies for the prevention of VAD
infections
1 Types of VADs and
insertion sites
Location:
- The location of the VAD
shuold be based on
the needs of the patient
- Risk of infection:
LOWER: single-lumen
HIGHER: multiple-lumen

12. Strategies for the prevention of VAD
infections
2 Barrier precautions
- Before the insertion or manipulation of any catheter,
do the following
Hand Hygiene:
- Antiseptic detergent
- Chlorhexidine (2-4%)
- Waterless alcohol
gel (>60%)

13. Strategies for the prevention of VAD
infections
2 Barrier precautions
- Before the insertion or manipulation of any catheter,
do the following
Gloves:
- Non sterile
- Sterile

14. Strategies for the prevention of VAD
infections
2 Barrier precautions
- Before the insertion or manipulation of any catheter,
do the following
For CVC insertion, use
maximum barrier
precautions:
- Long-sleeved
sterile gowns
- Masks
- Caps
- Sterile drapes
- Sterile gloves

15. Strategies for the prevention of VAD
infections
3 Intravenous teams
4 Cutaneous antisepsis
- Chlorhexidine 2% is
preferable
- Povidone-iodine 10% or
- Alcohol 70% can be used
- Professional team
specializing in the insertion
and care of VADs

16. Strategies for the prevention of VAD
infections
5 Care of insertion site and maintenance of VAD
Dressing
and
anchoring
Topical
antiseptic
creams

17. Strategies for the prevention of VAD
infections
5 Care of insertion site and maintenance of VAD
Replacement
Tubing system

18. Strategies for the prevention of VAD
infections
6 Anticoagulants and thrombolytics
- Professional team
specializing in the insertion
and care of VADs
Use Heparin lock
- When no infusion is
being given
- To prevent the
formation of thrombus
Heparin at 10 units/mL
- Long-term VADs
Heparin at 100 units/mL
- Long-term, fully implanted VADs
- Peripherally inserted central catheter (PICC)

19. Strategies for the prevention of VAD
infections
7 Additional recommendations
Peripheral VADs
- Selection of the VAD: based on its use, duration, and
experience of personnel
- Selection of site of insertion of VAD:
Upper
extremities
instead of
the lower
ones
- Hands
- Scalp
(newborn)
- Dorsum
of the
foot
Adults Children

20. Strategies for the prevention of VAD
infections
7 Additional recommendations
Peripheral VADs
- Management of VAD after insertion:
Evaluate
the site of
insertion
No antibiotics on
the site of insertion
Evaluate daily Avoid the usage of antibiotics

21. Strategies for the prevention of VAD
infections
7 Additional recommendations
Central VADs
- Including PICC and pulmonary catheters
Surveillance of VAD infections Educate personnel in charge of
VAD insertion

22. Strategies for the prevention of VAD
infections
7 Additional recommendations
Central VADs
- Including PICC and pulmonary catheters
Aseptic technique Dressing change

23. Strategies for the prevention of VAD
infections
7 Additional recommendations
Arterial VADs and pressure-monitoring devices

24. Strategies for the prevention of VAD
infections
7 Additional recommendations
Umbilical VADs

25. For more information, consult the following references:
References
1. O’Grady N, et al. Guidelines for the Prevention of Intravascular
Catheter Related Infections. MMWR (2002;51[RR10]:1-26.
Online: www.shea-online.org/Assets/files/position_papers/hicpac_cather.pdf
2. Crnich CJ and Maki DG. Intravascular Device Infections. In: APIC.
APIC Text of Infection Control and Epidemiology, ed 2,
Washington, 2005, Association for Professionals in Infection
Control, pp 24-1 to 24-26.