Venous Vexation: A Central Line Conundrum

A 3-month-old male with intestinal failure has a femoral Broviac in place for long-term IV access for TPN and is preparing for discharge.

The outer sheath of the Broviac is broken.

The patient had previously had hemodialysis access.

Approximately half of polled clinicians would repair a damaged Broviac with a kit.

Central line infection is the most common complication of central lines.

Multiple factors contribute to central line infection prevention, including hand hygiene, dental care (especially in hematology-oncology patients), and preventing mucosal barrier infections.

Dentists are involved in preventing central line infections in hematology-oncology patients.

Ethanol locks are used in high-risk patients, including those with short gut and some hematology-oncology patients, to help prevent central line infections.

In high-risk patients with central line infections, antibiotic locks are used as part of treatment.

For gram-positive central line infections, treatment through the line has approximately 90% success rate.

For gram-negative central line infections, treatment through the line has approximately 50% success rate.

Fungal central line infections are very difficult to clear through the line.

Current practice rarely involves removing infected central lines, in contrast to past practice when lines were frequently removed.

Discrepancies between surgeon-preferred dressings and hospital-standardized dressings lead to dressing changes that can result in line complications including infection and accidental removal.

Standardized dressing protocols can be undermined when recovery room or PACU nurses change dressings applied in the OR simply because they are not the standard dressing.

Posting pictures of standardized dressings in the OR and on central line carts helps ensure consistent dressing practices.