40 / 68
196
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23(4)
:192–198
Table 3
Summary of recommendations and degree of evidence and (references) (see - 1).
Always assess the need of inserting a catheter. If necessary,
a central venous line should be preferred over a PVC if
duration of intravenous treatment longer than 6 days or
blood transfusion, parenteral nutrition or chemotherapy.
I-A
17,18
If possible, PVC should not be placed in the lower
extremities or at the elbow crease due to higher risk of
phlebitis.
II-A
20,21
Insertion of PVC must be performed with the maximum
hygiene with no need for a surgical field. There are no
preferences as to which disinfectant solution to use.
I-A
9,22,23
An sterile dressing must be used to cover the insertion site
(gauze dressing or transparent semi permeate).
II-A
24,25
Adherence to pre-insertion checklist improves prevention
of complication outcomes.
I-A
10,31
The need for PVC should be assessed on daily basis. If it is
not necessary, it is advisable to remove the PVC.
II-A
18,32,33
The insertion site must be inspected daily. If abnormalities,
malfunction or discomfort at the subcutaneous site, PVC
should be removed.
III-A
17,34,35
No antiseptic cream/gel should be used at the insertion
site.
III-C
36
Closed connectors to access the PVC can be used; its
external surface must always be decontaminated.
II-A
37
Infusion sets can be utilized up to 96 h, exception made of
blood transfusion or lipid emulsions.
I-A
38,39
It is mandatory that the nursing files a daily record of the
PVC.
III-A
40
It is not advisable to remove PVC on a routine basis. PVC
should be replaced when clinically indicated.
I-A
18,41–51
It is advisable not to keep a PVC in place for over 5 days.
III-B
Unused catheters must be removed.
II-A
10,53,55
When there is suspicion of PVC inserted under suboptimal
conditions, it must be removed.
III-A
56,57
If there is suspicion of infection, it is not indicated to use
diagnostic technique leaving the PVC in place.
III-A
If there is a suspicion of catheter-related infection, the tip
of the PVC must be submitted for Microbiology.
Removed PVC non-suspected to be infected not need
Microbiology.
III-A
Empiric antibiotic treatment of PVC-related bacteremia
has to be deescalated according to microbiology results.
I-A
67,68
Continuous education in insertion and maintenance
guidelines is an appropriate way to reduce
complications.
I-A
74–87
a continuous education program leads to relaxation of the norm,
abandonment of good clinical practices and increase in infection
and complication rates. On the contrary, specific educational pro-
grams help in reducing infection rates.
82–87
There are different
ways to provide education. Education among peers has shown the
best benefits in guideline follow-up as the staff is engaged in edu-
cation.
It is advisable that the infection and complication rates are peri-
odically disclosed to the staff in charge of inserting PVCs. This
is positive reinforcement on guideline/protocol follow-up and a
warning if deviations occur. Furthermore, the adherence to the
checklist can be monitored (Table 2).
Source of funding
No external funding sources.
Conflict of interest
No conflicts of interest declared.
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