Management of central venous catheters in adult intensive care units in Australia: policies and practices

The aim of this study was to describe current practice for insertion and care of central venous catheters (CVCs) in intensive care units (ICUs) in Australia and to compare current practice with international guidelines. A prospective telephone survey was conducted to gather data that describe existing practices. A multivariate analysis of the data was conducted using clustering techniques. In the context of this study, cluster analysis was used to find groups with similar approaches to CVC practices. Forty Australian hospitals with level 2 or 3 ICUs as defined by ANZICS were randomly selected and four ICU nurses from each were randomly selected for interview. A total of 34 ICUs and 133 ICU nurses agreed to participate. All states and territories were represented. The majority of CVC management practices in Australian ICUs are consistent with the latest Centers for Disease Control and Prevention (CDC) guidelines. However, practices that did not comply with the recommendations included maximal sterile barrier precautions such as use of cap and mask, choice of dressing, catheter insertion site, cleansing of CVC port before CVC access, replacement of administration sets and CVCs, removal of CVCs and the choice of liquid soap over antiseptic containing soap. The heterogeneity of practice observed and the divergence from the CDC guidelines suggests that practices for insertion and care of CVCs in ICUs in Australia can be improved. Improved practice may result in lower rates of catheter-related bloodstream infection, save costs and improve health outcomes.