New Clinical Guidelines to Reduce Central Line-Associated Bloodstream Infection

Central venous catheters are essential in intensive care units, delivering life-saving medications, monitoring cardiovascular function, and supporting blood purification. However, their widespread use increases the risk of central line-associated bloodstream infections (CLABSI), a serious complication linked to higher mortality, prolonged hospital stay,s and increased healthcare costs. Now, new updated guidelines aim to standardize clinical practice and reduce these preventable infections.

The recommendations were developed by a multidisciplinary team led by West China Hospital of Sichuan University (Chengdu, China) and a working group from the Chinese Society of Critical Care Medicine (CSCCM). Published in two parts in the Journal of Intensive Medicine, the revised guidelines update recommendations first issued in 2007. The panel conducted systematic literature reviews, meta-analyses, and structured expert voting to finalize 52 recommendations for adult ICU patients with central lines.

The guidelines are divided into two sections: diagnosis and prevention, and catheter management following infection with appropriate antimicrobial use. For suspected infections, clinicians are advised to collect blood samples from both peripheral veins and catheter hubs to improve diagnostic accuracy. Prevention is strongly emphasized. Subclavian vein insertion is generally preferred over femoral or internal jugular sites due to lower infection risk. Routine ultrasound guidance during placement is recommended to improve accuracy and reduce complications.

The guidelines also recommend using the fewest catheter lumens necessary, antimicrobial-coated catheters, chlorhexidine-based skin preparation, and sterile transparent dressings. Daily reassessment and prompt removal of unnecessary catheters are emphasized to minimize infection risk. Routine blood sampling through central lines is discouraged unless clearly indicated. For high-risk patients, additional measures such as antimicrobial lock solutions and daily chlorhexidine bathing are recommended.

The updated framework translates decades of research into practical ICU protocols designed to reduce infection rates and improve outcomes for critically ill patients. By standardizing catheter insertion, maintenance, and infection management practices, the guidelines aim to lower CLABSI incidence globally.

“Many catheter-related infections are preventable if the recommended strategies are implemented properly. Our guidelines cover everything from early risk recognition to catheter selection to adherence to aseptic techniques,” noted the authors.

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West China Hospital of Sichuan University