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Copyright (c) 2025 Shaden Abdullah Alharbi, Yousef Tala Almutairi, Sheddi Raffaa Alshammari, Ranya Salem Baabbad, Ibrahim Suliman Alaboudi, Rawdah Mohammed Omar Alsomali, Amna Mohammed Ali Wahishi, Nahlah Abdulrahman Alfaraj
This work is licensed under a Creative Commons Attribution 4.0 International License.
Nursing Care and Pharmacists Management of Central Venous Catheters: Evidence-Based Practices for Safety and Infection Prevention
Corresponding Author(s) : Shaden Abdullah Alharbi
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Central Venous Catheters (CVCs) are indispensable for administering critical therapies in settings like intensive care, oncology, and hemodialysis. However, their use carries significant risks, with Central Line-Associated Bloodstream Infections (CLABSIs) being a foremost concern. CLABSIs contribute substantially to patient morbidity, mortality, and healthcare costs, underscoring the vital importance of evidence-based catheter management.
Aim: This article aims to provide a comprehensive review of evidence-based practices for the nursing care and management of CVCs, with a primary focus on strategies to prevent infections and enhance patient safety throughout the catheter lifecycle.
Methods: The review synthesizes established guidelines and best practices, covering CVC anatomy, indications, and contraindications. It details the essential equipment, personnel competencies, and meticulous techniques required for insertion, daily maintenance, and monitoring. The critical roles of sterile protocols, skin antisepsis with chlorhexidine, appropriate dressing selection, and securement devices are emphasized.
Results: Adherence to structured care bundles significantly reduces complications. Key results highlight that meticulous hand hygiene, maximal sterile barriers during insertion, daily chlorhexidine bathing, and the use of dedicated vascular access teams are proven to lower CLABSI rates. Furthermore, daily review of catheter necessity and prompt removal when no longer indicated are crucial for minimizing infection risk and healthcare costs.
Conclusion: Effective CVC management is a fundamental nursing responsibility that directly impacts patient outcomes. A consistent, multidisciplinary approach grounded in evidence-based protocols is essential for preventing complications and ensuring patient safety.
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- Lee KH, Cho NH, Jeong SJ, Kim MN, Han SH, Song YG. Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections. Yonsei medical journal. 2018 May:59(3):376-382. doi: 10.3349/ymj.2018.59.3.376.
- O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011 May:52(9):e162-93. doi: 10.1093/cid/cir257. Epub 2011 Apr 1
- Ferrara P, Albano L. The adherence to guidelines for preventing CVC-related infections: a survey among Italian health-care workers. BMC infectious diseases. 2018 Dec 3:18(1):606. doi: 10.1186/s12879-018-3514-x.
- Bell T, O'Grady NP. Prevention of Central Line-Associated Bloodstream Infections. Infectious disease clinics of North America. 2017 Sep:31(3):551-559. doi: 10.1016/j.idc.2017.05.007.
- Theaker C. Infection control issues in central venous catheter care. Intensive & critical care nursing. 2005 Apr:21(2):99-109
- Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS : acta pathologica, microbiologica, et immunologica Scandinavica. 2017 Apr:125(4):365-375. doi: 10.1111/apm.12665.
- Aurshina A, Hingorani A, Alsheekh A, Kibrik P, Marks N, Ascher E. Placement issues of hemodialysis catheters with pre-existing central lines and catheters. The journal of vascular access. 2018 Jul:19(4):366-369. doi: 10.1177/1129729818757964.
- Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet (London, England). 1991 Aug 10:338(8763):339-43
- Danks LA. Central venous catheters: a review of skin cleansing and dressings. British journal of nursing (Mark Allen Publishing). 2006 Jun 22-Jul 12:15(12):650-4
- Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infection control and hospital epidemiology. 1994 Apr:15(4 Pt 1):231-8
- Aloush SM, Alsaraireh FA. Nurses' compliance with central line associated blood stream infection prevention guidelines. Saudi medical journal. 2018 Mar:39(3):273-279. doi: 10.15537/smj.2018.3.21497.
- Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Central Line Catheters and Associated Complications: A Review. Cureus. 2019 May 22:11(5):e4717. doi: 10.7759/cureus.4717.
- Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR. Morbidity and mortality weekly report. 2011 Mar 4:60(8):243-8
- Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Techniques in vascular and interventional radiology. 2011 Dec:14(4):217-24. doi: 10.1053/j.tvir.2011.05.003
- Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg RP, Ebadi E. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PloS one. 2020:15(1):e0227772. doi: 10.1371/journal.pone.0227772.
- Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O'Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infection control and hospital epidemiology. 2014 Sep:35 Suppl 2():S89-107
- Cai Y, Zhu M, Sun W, Cao X, Wu H. Study on the cost attributable to central venous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China. Health and quality of life outcomes. 2018 Oct 11:16(1):198. doi: 10.1186/s12955-018-1027-3.
- Xiong Z, Chen H. Interventions to reduce unnecessary central venous catheter use to prevent central-line-associated bloodstream infections in adults: A systematic review. Infection control and hospital epidemiology. 2018 Dec:39(12):1442-1448. doi: 10.1017/ice.2018.250.
- Wei L, Li Y, Li X, Bian L, Wen Z, Li M. Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis. BMC infectious diseases. 2019 May 16:19(1):429. doi: 10.1186/s12879-019-4029-9.
- Alonso-Echanove J, Edwards JR, Richards MJ, Brennan P, Venezia RA, Keen J, Ashline V, Kirkland K, Chou E, Hupert M, Veeder AV, Speas J, Kaye J, Sharma K, Martin A, Moroz VD, Gaynes RP. Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infection control and hospital epidemiology. 2003 Dec:24(12):916-25
References
Lee KH, Cho NH, Jeong SJ, Kim MN, Han SH, Song YG. Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections. Yonsei medical journal. 2018 May:59(3):376-382. doi: 10.3349/ymj.2018.59.3.376.
O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011 May:52(9):e162-93. doi: 10.1093/cid/cir257. Epub 2011 Apr 1
Ferrara P, Albano L. The adherence to guidelines for preventing CVC-related infections: a survey among Italian health-care workers. BMC infectious diseases. 2018 Dec 3:18(1):606. doi: 10.1186/s12879-018-3514-x.
Bell T, O'Grady NP. Prevention of Central Line-Associated Bloodstream Infections. Infectious disease clinics of North America. 2017 Sep:31(3):551-559. doi: 10.1016/j.idc.2017.05.007.
Theaker C. Infection control issues in central venous catheter care. Intensive & critical care nursing. 2005 Apr:21(2):99-109
Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS : acta pathologica, microbiologica, et immunologica Scandinavica. 2017 Apr:125(4):365-375. doi: 10.1111/apm.12665.
Aurshina A, Hingorani A, Alsheekh A, Kibrik P, Marks N, Ascher E. Placement issues of hemodialysis catheters with pre-existing central lines and catheters. The journal of vascular access. 2018 Jul:19(4):366-369. doi: 10.1177/1129729818757964.
Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet (London, England). 1991 Aug 10:338(8763):339-43
Danks LA. Central venous catheters: a review of skin cleansing and dressings. British journal of nursing (Mark Allen Publishing). 2006 Jun 22-Jul 12:15(12):650-4
Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infection control and hospital epidemiology. 1994 Apr:15(4 Pt 1):231-8
Aloush SM, Alsaraireh FA. Nurses' compliance with central line associated blood stream infection prevention guidelines. Saudi medical journal. 2018 Mar:39(3):273-279. doi: 10.15537/smj.2018.3.21497.
Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Central Line Catheters and Associated Complications: A Review. Cureus. 2019 May 22:11(5):e4717. doi: 10.7759/cureus.4717.
Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR. Morbidity and mortality weekly report. 2011 Mar 4:60(8):243-8
Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Techniques in vascular and interventional radiology. 2011 Dec:14(4):217-24. doi: 10.1053/j.tvir.2011.05.003
Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg RP, Ebadi E. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PloS one. 2020:15(1):e0227772. doi: 10.1371/journal.pone.0227772.
Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O'Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infection control and hospital epidemiology. 2014 Sep:35 Suppl 2():S89-107
Cai Y, Zhu M, Sun W, Cao X, Wu H. Study on the cost attributable to central venous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China. Health and quality of life outcomes. 2018 Oct 11:16(1):198. doi: 10.1186/s12955-018-1027-3.
Xiong Z, Chen H. Interventions to reduce unnecessary central venous catheter use to prevent central-line-associated bloodstream infections in adults: A systematic review. Infection control and hospital epidemiology. 2018 Dec:39(12):1442-1448. doi: 10.1017/ice.2018.250.
Wei L, Li Y, Li X, Bian L, Wen Z, Li M. Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis. BMC infectious diseases. 2019 May 16:19(1):429. doi: 10.1186/s12879-019-4029-9.
Alonso-Echanove J, Edwards JR, Richards MJ, Brennan P, Venezia RA, Keen J, Ashline V, Kirkland K, Chou E, Hupert M, Veeder AV, Speas J, Kaye J, Sharma K, Martin A, Moroz VD, Gaynes RP. Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infection control and hospital epidemiology. 2003 Dec:24(12):916-25