Infection prevention and control

Vascular access device clinical management for infection prevention

What to know

Vascular access devices are used in healthcare settings to administer intravenous medications, fluids, blood products, nutrition and for haemodynamic monitoring. All types of vascular access devices provide direct access to a patient’s bloodstream.

Vascular access devices can cause various complications, including healthcare associated infections. In Australia there are approximately 165,000 healthcare associated infections annually, which equates to 7% of all hospitalised patients. The risk of infection associated with vascular access devices is significantly reduced when healthcare staff comply with evidenced-based practice and recommendations for the insertion, management, and removal of vascular access devices.

About this guideline

The Vascular access device clinical management for infection prevention guideline provides the key practice points for vascular access device management.

Vascular access device clinical management for infection prevention (PDF 1105 kB)

Quick reference guide

Clinician quick reference guide for vascular access device clinical management for infection prevention.

	Key points
Education and competency	Clinicians who insert, manage, and remove vascular access devices must undertake formal education and competency assessment. Healthcare facilities are responsible for developing, implementing, and maintaining education and competency assessment processes. Healthcare facilities are responsible for maintaining assessment records in alignment with the accreditation standards.
Documentation	Insertion must be documented in the medical record and include the relevant minimum data set as outlined in 3.1. Documentation of vascular access device management must occur a minimum of once every eight hours for the inpatient setting and on each encounter for the outpatient and community settings. Document all adverse events within the state-wide information system RiskMan.
Neonates	The recommendations contained in this guideline do not pertain to neonatal infants who have received uninterrupted care in a neonatal intensive and/or special care unit since birth. Please refer to your local facility policies/guidelines and the neonatal Queensland Clinical Guidelines for recommendations regarding the care of neonatal patients. Clinical decisions for this population must be made in consultation with a neonatologist.
Pre-insertion	Select a vascular access device that minimises vessel damage, supports vessel preservation, and promotes patient comfort, by considering: therapy duration and frequency patient factors and co-morbidities therapy/medication type. Care bundles are crucial to reduce infection and should be applied during the pre-insertion, insertion, and maintenance phases of vascular access.
Insertion	Insertion must be documented in the medical record and include the relevant minimum data set as outlined in 3.1. Site selection is critical to promote vessel health, reduce infection and prolong the life of the vascular access device. Skin antisepsis must be strictly maintained to prevent infection. Apply standard precautions according to the device type, including aseptic technique, hand hygiene, barrier precautions, and personal protective equipment. Sterile probe covers and sterile gel must be used when clinicians are using ultrasound to guide insertion. Device securement is vital to prevent migration and accidental dislodgement. Prophylactic antibiotic therapy is not routinely recommended.
Post-insertion	All vascular access devices must be reviewed every eight hours routinely or hourly where there is a continuous infusion or clinical indication. All reviews must be documented in the medical record and must include a site observation, dressing and securement status, device function, external catheter measurements (midline and central devices only), clinical indication for the device, and patient reported concerns. Clinicians must not reinforce dressings with non-sterile tape. Dressings that are blood stained, wet, or lifting, must be replaced. Clinicians should ensure a needleless connector or cap is applied to each lumen and replaced with the administration set or weekly at a minimum. Needleless connectors must be decontaminated with 70% isopropyl alcohol or a combination of 70% isopropyl alcohol and chlorhexidine gluconate for 15 seconds and allowed to dry prior to each access. Replace administration sets at the recommended intervals according to device and infusion type. Discard disconnected administration sets immediately, do not reconnect. Flush and lock the device after each access. Clinicians must be familiar with the correct locking sequence for the type of needleless connector utilised Positive displacement – flush, disconnect, clamp Negative displacement – flush, clamp, disconnect Anti-reflux – No specific sequence, however, clamping is advised. Catheter migration should be reported immediately to the treating team and appropriate steps taken to mitigate risk to the patient.
Replacement and removal	Adhere to the recommended dwell time of individual types of vascular access devices. Peripheral intravenous catheter clinically indicated removal is not recommended in the absence of robust surveillance programs, sustained compliance with routine documentation and training programs that are standardised. Central venous access devices should not be routinely replaced. All devices inserted in an emergency setting where aseptic technique is unknown or has not been maintained must be removed as soon as possible. Clinicians should remove devices where signs and symptoms of infection are evident. Healthcare facilities must provide guidance on the requirements for the removal of vascular access devices.
Diagnosis and surveillance of HAI	2 x sets of blood cultures should be collected if a catheter infection is suspected (collect 1 x peripheral set and 1 x catheter set). Blood cultures are required to formally diagnose a blood stream infection. A positive catheter tip is insufficient. Tip cultures are not routinely required where line infection is not suspected. Ensure needleless connectors are thoroughly decontaminated or removed and the lumen decontaminated prior to culture collection. Ensure culture bottles are filled to the designated line or etched marker. Surveillance and reporting of infections should be in alignment with the Queensland Health Healthcare associated infection surveillance guideline.
Monitoring and audit	Compliance with the procedure may be monitored through healthcare associated infection surveillance and post-procedure investigation of any infected-related complication.

Clinician quick reference guide for vascular access device clinical management (PDF 152 kB)

Implementation

The following resources have been developed to assist with implementing the guideline locally.

Scrub the stopper

Information for consumers

You have had a vascular access device inserted, commonly known as a “drip” or “cannula”. Medication, fluids and sometimes nutrition are administered directly to your blood stream through your vascular access device.

Infections in these devices can occur, so we will do everything that we can to prevent this.

Your device has different parts, which may include:

Catheter – the part inserted into your vein, also known as a “cannula” or “drip”.
Line – thin flexible plastic tubing, which connects to a bag or syringe. You might not have one.
Needleless connector – the part where medications are injected, also known as a “bung”, “port” or “cap”.
Dressing – a protective covering to stop your device falling out.

What you need to know

You can expect us to tell you:

the type of device you have
why it was inserted
how to care for it
how long you will have it for
how often it may need to be changed
the possible risks associated with your device.

Your role and consent

If you have questions about your device or any other aspect of your care, please talk with your care team. As with all care that we provide to you, we will seek your consent before inserting and each time we touch your device.

Download the consumer guide for more information:

Consumer guide - Vascular access device clinical management for infection prevention (PDF 180 kB)

Evidence statement

The content on this page is informed by the Guideline document (Vascular access device clinical management for infection prevention (PDF 1105 kB)). As such, it is not directly referenced for ease of reading. Extensive detail on the evidence base and key recommendations can be found in the Guideline document, which is fully referenced (Vascular access device clinical management for infection prevention (PDF 1105 kB)).