The nurse on the IV therapy team is making rounds in the intensive care unit on clients with central venous catheters. Which central line should be removed earliest to prevent infection? A)Femoral line inserted in emergency department post cardiac arrest 48 hours ago B)Internal jugular line inserted 6 days ago in operating room C)Peripherally inserted central catheter line with one lumen occluded that was placed 2 weeks ago D)Subclavian line with slight redness at anchor suture sites inserted in intensive care unit 72 hours ago

Question

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In adult clients, central venous access sites in the upper body (internal jugular or subclavian) are preferred to minimize the risk of infection. Access sites in the inguinal area (femoral) are easily contaminated by urine or feces, and it is difficult to place an occlusive dressing over these sites. A central venous catheter (CVC) should be placed where aseptic technique can be applied. The site should be assessed daily for signs/symptoms of infection (eg, redness, swelling, drainage). The duration of CVC placement should be based on clinical need and judgment that there is no evidence of infection. (Option B) Although this site has been in use for 6 days, it is a preferred site; the CVC was inserted in the operating room, where surgical asepsis was easily accomplished. The site can be used as long as there is a clinical need and no evidence of infection. (Option C) Peripherally inserted central catheter (PICC) lines can be left in for weeks or months. The occlusion of one lumen does not necessitate removal of the catheter. (Option D) The subclavian vein is a preferred site for a CVC. Although slight redness is present at the suture sites, it is not located at the insertion site. The femoral line is still at higher risk for infection. Educational objective: Femoral central venous catheters may be placed in emergency situations but should be removed/replaced as soon as possible due to the high risk of contamination and infection.

The Nurse on the IV Therapy Team Is Making Rounds