Avoid the subclavian site in hemodialysis patients and patients with advanced kidney disease, to avoid subclavian vein stenosis.No recommendation can be made for a preferred site of insertion to minimize infection risk for a tunneled CVC.Use a subclavian site, rather than a jugular or a femoral site, in adult patients to minimize infection risk for nontunneled CVC placement.Avoid using the femoral vein for central venous access in adult patients.Weigh the risks and benefits of placing a central venous device at a recommended site to reduce infectious complications against the risk for mechanical complications (e.g., pneumothorax, subclavian artery puncture, subclavian vein laceration, subclavian vein stenosis, hemothorax, thrombosis, air embolism, and catheter misplacement).Remove peripheral venous catheters if the patients develops signs of phlebitis (warmth, tenderness, erythema or palpable venous cord), infection, or a malfunctioning catheter.If the patient has local tenderness or other signs of possible CRBSI, an opaque dressing should be removed and the site inspected visually. Gauze and opaque dressings should not be removed if the patient has no clinical signs of infection. Evaluate the catheter insertion site daily by palpation through the dressing to discern tenderness and by inspection if a transparent dressing is in use.Use a midline catheter or peripherally inserted central catheter (PICC), instead of a short peripheral catheter, when the duration of IV therapy will likely exceed six days.Avoid the use of steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs.Select catheters on the basis of the intended purpose and duration of use, known infectious and non-infectious complications (e.g., phlebitis and infiltration), and experience of individual catheter operators.In pediatric patients, the upper or lower extremities or the scalp (in neonates or young infants) can be used as the catheter insertion site.

Replace a catheter inserted in a lower extremity site to an upper extremity site as soon as possible. In adults, use an upper-extremity site for catheter insertion.Peripheral and Midline Catheter Recommendations Additionally, infection risk increases with nursing staff reductions below a critical level. Specialized “IV teams” have shown unequivocal effectiveness in reducing the incidence of CRBSI, associated complications, and costs. Reports spanning the past four decades have consistently demonstrated that risk for infection declines following standardization of aseptic care and that insertion and maintenance of intravascular catheters by inexperienced staff might increase the risk for catheter colonization and CRBSI. Well-organized programs that enable healthcare providers to become educated and to provide, monitor, and evaluate care are critical to the success of this effort. Observational studies suggest that a higher proportion of “pool nurses” or an elevated patient–to-nurse ratio is associated with CRBSI in ICUs where nurses are managing patients with CVCs. Ensure appropriate nursing staff levels in ICUs.Designate only trained personnel who demonstrate competence for the insertion and maintenance of peripheral and central intravascular catheters.

Periodically assess knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of intravascular catheters.

Educate healthcare personnel regarding the indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters, and appropriate infection control measures to prevent intravascular catheter-related infections.

Medical asepsis technique catheter