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Central line associated bacteraemia (CLAB) high risk criteria and management

Date last published:

Children in the paediatric intensive care unit (PICU) with central venous lines (CVL) in situ are at high risk of developing central line associated bacteraemia.

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Paediatric intensive care

Introduction

Children in the paediatric intensive care unit (PICU) with central venous lines (CVL) in situ are at high risk of developing central line associated bacteraemia. This guideline is intended to highlight the additional infection prevention measures required for patients in PICU.

Standard Infection Prevention measures

Central line care for all patients in PICU should follow the insertion and maintenance bundles outlined in the Starship central venous catheter guideline.

PICU patients should have an antimicrobial dressing placed at the insertion site of all central lines, including percutaneous lines, vascaths, ECMO cannulae and femoral arterial lines. If a patient is admitted to PICU with a central line in situ the dressing should be changed to an antimicrobial dressing at the next routine dressing change. This does not apply to long term surgically implanted lines but applies to all other central lines.

If the patient is admitted to PICU with the central line in situ and it is unclear whether the insertion complied with the insertion bundle criteria, consider changing the central line. There is no evidence for routine central line changes.

High risk patients

The following patients are considered to be at high risk of developing CLAB:

  • All patients on ECMO

  • All patients with an open chest

  • All patients with VAD in situ

  • Immunosupressed patients:

    • Transplantation

    • Neutropenic patients (PMN <0.5)

    • Chronic steroid use

    • Chronic protein loss eg nephrotic syndrome, chylothoraces, PLE

    • Chronic liver failure

    • Known immune deficiency

  • CVL in situ > 1 week

  • Patient in hospital > 1 week and CVL in situ

  • All patients who are colonised with multi- resistant Acinetobacter, ESBL, VRE or MRSA

In addition to the standard infection prevention measures these patients should receive a daily full body (to jaw line) wipe with Chlorhexidine 2% wash cloths following their daily wash. Do not apply to broken skin and cease if contact allergy occurs. Do not use in infants < 37 weeks gestation. Any new CVL inserted must be antimicrobial coated with chlorhexidine and silver sulfadiazine.

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