You ’ re in a patient room for at least 30 to 60 minutes on average from the time you enter with your supplies to the time you place the line , and sometimes longer .
If you have a lot of patients who have PICC and central access lines , you may not have enough specialists to be inserting lines for everybody .”
— Kelly Cawcutt , MD
help us to drive those recommendations . That is what shifts the needle on guidelines .”
Cawcutt continues , “ When you talk about unresolved issues , one of the things that is beautiful about this update is that every person who ’ s interested in CLABSI is going to read this Compendium at some point , and they ’ re going to discern where there are gaps in the evidence . That helps researchers and healthcare professionals in the realm of infection control understand the areas in which more research is needed to help decide how to resolve these gaps for the next update of the Compendium .”
Let ’ s review the major revisions for 2022 .
The updated Compendium emphasizes the subclavian vein as the preferred site for central venous catheter ( CVC ) insertion in the intensive care setting to reduce infectious complications . Previously , the primary recommendation was to avoid the femoral vein for access . Although this remains valid , it has been replaced by a positively formulated recommendation regarding the subclavian site .
The recommendation to use ultrasound guidance for catheter insertion is backed by better evidence than was available previously ; however , the procedure itself may jeopardize the strict observation of sterile technique .
The use of chlorhexidine-containing dressings is now considered an “ essential practice ;” in the past , it was listed under special approaches that should only be employed if CLABSI rates remain high despite the implementation of basic practices .
Routine replacement of administration sets not used for blood , blood products , or lipid formulations can be performed at intervals of up to seven days . Previously , this interval was no longer than four days .
One of the tougher issues tackled by the Compendium authors is product-driven unresolved issues .
“ The Compendium doesn ’ t call out specific brand or trademarked items ; there is a recognition that there are many products and there is this tension between the healthcare marketplace and the healthcare community ,“ Cawcutt acknowledges . “ Everyone wants to uphold patient care , but we ’ re not sure who does it best . At some point , though , medicine must evolve with the technology , and we need to test these product-based or industry-driven studies , or we will never be able to evolve our practice . There must be a recognition that we can do better things with better technology , updated devices and improved materials in these devices . So , I think we must recognize that there is a little bit of give and take there , but when products make it to market , it ’ s our due diligence to ask ourselves , does this product , device or technology provide something more than what we ’ re offering our patients now ? Does it provide a higher level of protection from infection without additional risk ? Does it present sufficient value without additional risk , and if so , it should be evaluated further and potentially implemented . We should always be thinking critically about technological advances , what should be integrated and what studies we need to help us make informed decisions as catheter care evolves .”
Other product-driven issues addressed by the Compendium include antimicrobial ointment for the catheter site — geared toward the population of hemodialysis patients — which has been moved to “ additional practices ” given the focus on a specific population . Also , despite currently being supported by high-level evidence , antiseptic-containing caps remain an “ additional practice ” because they are not considered superior to the manual disinfection , an essential practice , according to the Compendium .
In another change for 2022 , the updated Compendium now addresses the importance of infusion teams as an “ additional practice ,” where previously it was considered an unresolved issue . Some experts say that vascular access specialists and specialty teams contribute to the reduction in CLABSI rates , the avoidance of adverse events , and improved patient outcomes and experiences .
“ Having a specialized team for vascular access to help in overwhelmed hospitals is a good idea , because we know that putting in a central line is not a 5-minute procedure ,” Cawcutt confirms . “ You ’ re in a patient room for at least 30 to 60 minutes on average from the time you enter with your supplies to the time you place the line , and sometimes longer . If you have a lot of patients who have PICC and central access lines , you may not have enough specialists to be inserting lines for everybody . I think we can say our patients need high-quality , expert vascular access assessment and placement and we need to look at how we can do that expeditiously and in a way that supports the teams in which there is no one who can place that line . You also need to think about peripheral IVs , midline catheters , PICC line catheters , or if the patient needs a dialysis catheter or emergent central line catheter , but still falling to your clinicians , your anesthesiologists , your emergency room physicians , your surgical team . I think that role needs to be maintained . I think specialists must maintain their skill sets . Regarding vascular access teams , yes , there ’ s an initial cost for staffing , for training all those people , and the flip side to that is if you have excellent vascular access and you have ways where perhaps you improve the consistency and insertion of certain types of lines , that becomes financially viable quickly , and if it helps decrease the risk of additional infections like CLABSIs , that may help prevent punitive costs later , that ’ s an advantage .”
We know that addressing CLABSI rates – whether through products or practice , or both – is an imperative due to the burden of outcomes associated with hospital-acquired CLABSI , including increased length of hospital stay , increased cost ( the adjusted variable costs for patients with CLABSI were $ 32,000 in 2010 U . S . dollars , for example ), as well as increased