Reducing blood stream infections during catheter insertion.

BACKGROUND: Registered radiologist assistants (R.R.A.s) and other health care providers frequently are responsible for placing peripherally inserted central catheter (PICC) lines. Postprocedure blood stream infections are a potentially costly and medically serious complication.

PURPOSE: To determine the most effective methods for R.R.A.s and other health professionals to reduce blood stream infections related to PICC line insertion and management.

METHODS: Using specific inclusion criteria, the authors searched for scholarly reviewed articles related to PICC lines, infection, and adulthood.

RESULTS: The search produced 2237 articles, from which the authors selected 35 for review, in addition to 6 articles identified in the reference lists of articles not selected. The authors investigated 6 topics related to infection control in PICCs among nonimmunocompromised adults: securement devices, staff education, needleless systems, site preparation, maximum sterile barriers, and antimicrobial patches.

CONCLUSION: In the long run, proactive continuing education is less expensive than the cost of complications caused by postprocedure infections. Although further research is needed, specific strategies reported in the literature included prepping the skin using chlorhexidine and antimicrobial patches to reduce the microorganisms in the area. These steps should be followed by maximum sterile barriers. Needleless connectors and positive-pressure valves were found to be more effective than the alternatives, and proper securement with self-adhesive anchoring devices was found to be more effective than suturing for reducing blood stream infections.