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