4. Infection

a. Infection is the most common complication of central

venous catheters, with the smallest and most immature infants being at greatest risk. Catheter-related sepsis (CRS) rates range from 0% to 29% of lines placed

and from 0.4 to 17 per 1,000 catheter days (2,3).

b. Strict protocols for central line care and a methodology of surveillance with a data feedback mechanism

are recommended to decrease CRS (2,3,13).

c. Management of catheter-related sepsis: Remove

central venous line if possible. Prompt removal of

the line is recommended for Staphylococcus

aureus, gram-negative, or Candida sepsis.

Treatment with appropriate antibiotics without

removal of the line may be attempted in infants

with coagulase-negative Staphylococcus sepsis, but

repeated positive cultures mandate removal of the

line (18,19).

5. Catheter dysfunction

a. Obstruction of the catheter is characterized by

increased pump pressures, or inability to infuse fluids or withdraw blood.

b. Dysfunction may be due to malposition, fibrin

thrombosis, precipitates caused by minerals or

drugs, or lipid deposits (22).

c. Management

(1) Check catheter position on chest radiograph.

(2) If malposition is ruled out, review history of fluids and drugs administered through the catheter

to determine probable cause of occlusion.

A C

B D

Fig. 32.14. Various venous malpositions of PICCs. A: Jugular. B: Tip in right atrium C: PICC from left

arm, through superior vena cava and right atrium, into inferior vena cava. D: PICC from saphenous vein

in leg entering vertebral venous plexus via ascending lumbar vein.