Arterial Line Bloodstream Infection

CNL2B · Jun 22, 2010

Studenthawk --

I have never seen a bloodstream infection that has been pinned to an arterial line in practice. They typically don't get infected because of the direction of the blood flow. You might want to see if there is any data out there you could even dig up about infected arterial lines, because I think it rarely happens. I have on occasion seen a localized skin infection, but not a bloodstream infection. I think you are probably going to want to focus your assignment on venous lines only because of the data availability.

Thank said, all invasive lines are placed under sterile technique these days for infection control purposes, including art lines. Most facilities have gone to a full length drape, a chlorhexidine based prep, and a gown/mask/cap for the person doing the procedure. All in the room should wear masks. Not that everyone does it that way --- (I have seen plenty of old anesthesiologists put on a pair of gloves and go to it) but that is best practice.

LouisVRN, RN · Jun 22, 2010

We don't have art lines on the floor I work, that being said trying to prevent bloodstream venous infections is hard enough for some to follow all the policies and procedures. Where I work the rule of thumb is if its primary tubing that is continually infusing iv bag needs to be changed q 24 hours and tubing q 96 hours. On a periphreal site the site needs to be changed q 96 hours, on a central line initial dressing change after 24 hours with a biopatch and then q 7 days. Secondary and non-continual primary lines need to be changed q 24 hours. We now have color coded stickers for the date they need to be changed and it still isnt done. I'd say I'm the only one that marks IV bags and probably one of a handful that marks my tubing. Even if you focus your paper just on venous lines there is a TON of education needed to emphasize why best practice needs to be followed 100% of the time and not just when you have time. I also educate all my pts/families as to when their IV tubing needs to be changed, sometimes they have nothing better to do than sit around and make sure they get the best care possible.

shiccy · Jun 22, 2010

I've never read the documentation closely enough for a central line insertion, but we have a PPO for it and "Time out" documentation.

I can tell you about our line changes, though. Our line dressings are changed w/in 24hours of insertion or 1 week (7 days). We flush Q8h w/ turbulent flushing of 10ml of 0.9NS for each port. We used to have negative pressure caps, but those are changed Q96h or sooner. With OUR unit we change dressings on Monday and Caps on Monday and Thursday. Because of this our floor (and hospital) CVLBSI's have decreased markedly. We still have had a few, but not many.

As far as the kit is concerned, we have alcohol swabs x 3 that we wipe on concentric circles starting on the inside and moving out. After that is a 30 second scrub of chlorihexidine (sic?), followed by a clorihexidine biopatch (also good for 7 days). Followed by a semi-occlusive dressing, and then our occlusive dressings have 2 strips on them to cover the area further. The of the occlusive dressing where the lines come out are long enough to dog-tail under the line on both sides, and then we have the 2 strips one for under and one for over the lines. This makes a "better" closing (I call BS, but it's protocol).

We also use tube minders for two reasons ... doesn't tug on the tubes as much, but also doesn't let the ports flop around making the opening for the CVL bigger.

Oh and we use sterile gloves and we AND the patient are to wear masks, or alternatively look the opposite way from the dressing change. I also close the door so people don't walk in willy nilly.

Altra, BSN, RN · Jun 22, 2010

Have you done a literature search? Citations from literature could be most helpful when you present your proposal.

Moneymn316 · Jun 23, 2010

Aline infections are very low in occurrence. This is primarily because it is a closed system that does not have frequents connection and disconnection of IV fluids/medications.

As for my hospital.

The site is cleaned with chlorohexidine (sp?). Physicians must wear sterile gloves, cap and gown as with central line placement. Tegaderm dsgs are used for this. Tubing is changed every 72 hours. Ideally an Aline should not be left in for more that 3 days as with a peripheral IV.

We are also currently trialling chlorohexidine impregnated tegaderm dressings to reduce infections.

Advanced Practice Columnist / Guide · Jun 23, 2010

I am working on a project to reduce catheter associated bloodstream infections. Rather than just focusing on central lines, I am also looking at arterial lines.
What precautions does your hospital take when placing art lines?
How often do you change the dressing and tubing?
What type of dressing do you use?
Any information would be helpful.
Thank you!

I am a nurse practitioner in the ICU and while I do place arterial catheters, I do not provide catheter maintenance and do not know the details on how often the dressings and lines are changed by the bedside nurses. However, I have worked in two different hospital systems and in one, the provider who inserts the catheter utilizes full barrier protection in terms of donning sterile gown, mask, gloves, and hats as well as using an arterial line kit that contains a sterile drape and chlorhexidine swabs regardless of cathere site insertion (i.e., femoral, radial). In the other hospital, the full barrier protection is only utilized when inserting femoral arterial catheters. Radial catheters are inserted using an Arrow Radial Artery Catheterization Set, the site is swabbed with Chlorhexidine, and the inserter wears sterile gloves and a mask with no requirement for sterile gown.

More importantly, the reason why I posted is to give you kudos for being astute in adding arterial lines in your project. Recent efforts in preventing Catheter-Related Bloodstream Infections (CRBSI's) have largely focused on central venous catheters (CVC's). However, recent studies do show that arterial catheters have similar rates of infection as CVC's. See the studies below:

1. Koh, DBC et al. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters. Critical Care Medicine. Volume 36(2), February 2008, pp 397-402.

2. Traore, O et al. Prospective study of arterial and central venous catheter colonization and of arterial- and central venous catheter–related bacteremia in intensive care units. Critical Care Medicine. Volume 33(6), June 2005, pp 1276-1280.

There is also a study below that showed that rates of infection among arterial cathers vary depending on insertion site with those inserted in the femoral artery having the greatest risk of infection. I'm sure you and I agree as to why that is so.

1. Lorente, L et al. Arterial catheter-related infection of 2,949 catheters. Critical Care. Volume 10(3), May 2006.

In light of the above studies (and I'm sure you'll find more if you do a search), I wouldn't be surprised if future CDC guidelines pay the same attention to arterial catheters as they do CVC's.