Keeping Central Lines Sterile

Central line infection prevention starts before the needle: unnecessary central venous catheters should not be placed. For CLABSI prevention, current IDSA and SHEA guidance favors ultrasound-guided insertion, maximal sterile barriers, chlorhexidine skin prep, and subclavian access when feasible.

Central Line Sterility Essentials

• Indication before insertion: The first infection-prevention step is avoiding unnecessary central access; every nonessential catheter carries CLABSI risk and should be removed once it is no longer needed.
• Training and competency standards: Operator skill is part of sterility, not separate from it; guidelines call for formal education and competency assessment for both inserters and the staff maintaining the line.
• Subclavian site preference: Subclavian access is the preferred site to reduce infectious complications, a high-evidence recommendation that meaningfully reframes routine site selection in the right patient.
• Ultrasound and sterile barriers: Ultrasound guidance is recommended alongside maximal sterile barrier precautions, pairing better cannulation practice with lower contamination risk. We get into the practical insertion habits in the episode.
• Chlorhexidine skin antisepsis: Alcoholic chlorhexidine is the recommended skin prep, and chlorhexidine-containing dressings are favored in patients older than 2 months as part of ongoing CLABSI prevention.
• What not to do: Two common reflexes do not help: prophylactic antimicrobials are not recommended for short-term or tunneled lines, and routine catheter replacement should not be done.

References:

1. Buetti N, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 May;43(5):553-569. PMID: 35437133.