En la Guidelines
for the Prevention of Intravascular Catheter-Related Infections, 2011 desarrollada
por el CDC se ofrecen numerosas respuestas a esas cuestiones.
Veamos algunas, a modo de ejemplo:
¿Debemos usar guantes
estériles o no para la canalización de vías?
Pues NO para periféricos y SI para el resto.
1. Wear clean gloves, rather than sterile
gloves, for the insertion of peripheral intravascular catheters, if the access
site is not touched after the application of skin antiseptics. Category IC
2. Sterile gloves should be worn for the
insertion of arterial, central, and midline. Category IA
¿Yodo o clorhexidina?
Pues yodo, clorhexidina o alcohol para periféricos.
1. Prepare clean skin with an antiseptic (70%
alcohol, tincture of iodine, or alcoholic chlorhexidine gluconate solution)
before peripheral venous catheter insertion. Category IB
Clorhexidina en accesos centrales, salvo que esté
contraindicada.
2. Prepare clean skin with a >0.5%
chlorhexidine preparation with alcohol before central venous catheter and
peripheral arterial catheter insertion and during dressing changes. If there is
a contraindication to chlorhexidine, tincture of iodine, an iodophor, or 70%
alcohol can be used as alternatives. Category IA
3. No comparison has been made between using
chlorhexidine preparations with alcohol and povidone-iodine in alcohol to
prepare clean skin. Unresolved issue.
4. No recommendation can be made for the
safety or efficacy of chlorhexidine in infants aged <2 months. Unresolved
issue
Eso sí, dejándolos secar.
5. Antiseptics should be allowed to dry
according to the manufacturer’s recommendation prior to placing the catheter. Category
IB
¿Apósito de gasa o
transparente?
Pues parece que da igual…
1. Use either sterile gauze or sterile,
transparent, semipermeable dressing to cover the catheter site. Category IA
Salvo en pacientes que suden
mucho, sangren o exuden, en los que se optará por apósitos de gasa:
2. If the patient is diaphoretic or if the
site is bleeding or oozing, use a gauze dressing until this is resolved.
Category II
Y ¿Cada cuánto cambiar
los apósitos?
Siempre que se humedezcan, se suelten o se ensucien:
3. Replace catheter site dressing if the
dressing becomes damp, loosened, or visibly soiled. Category IB
Y de forma rutinaria, cada 2 días los de gasa estéril.
4. Replace dressings used on short-term CVC
sites every 2 days for gauze dressings. Category II
Y hasta 7 días en los
apósitos transparentes.
5. Replace dressings used on short-term CVC
sites at least every 7 days for transparent dressings, except in those
pediatric patients in which the risk for dislodging the catheter may outweigh
the benefit of changing the dressing. Category IB
6. Replace transparent dressings used on
tunneled or implanted CVC sites no more than once per week (unless the dressing
is soiled or loose), until the insertion site has healed. Category
II
En cualquier caso, deberá monitorizarse regularmente
su normalidad y sobre todo en pacientes que refieran dolor en la zona de
inserción, fiebre, etc.
7. Monitor the catheter sites visually when
changing the dressing or by palpation through an intact dressing on a regular
basis, depending on the clinical situation of the individual patient. If
patients have tenderness at the insertion site, fever without obvious source,
or other manifestations suggesting local or bloodstream infection, the dressing
should be removed to allow thorough examination of the site. Category IB
Y animar a los pacientes a que comuniquen cualquier
cambio que consideren relevante.
8. Encourage patients to report any changes
in their catheter site or any new discomfort to their provider. Category II
Y ¿Cada cuánto cambiar
los catéteres?
Los periféricos, no antes de 72-96 horas.
1. There is no need to replace peripheral
catheters more frequently than every 72-96 hours to reduce risk of infection
and phlebitis in adults. Category 1B
Los centrales, no deben cambiarse de forma rutinaria.
2. Do not routinely
replace CVCs, PICCs, hemodialysis catheters, or pulmonary artery catheters to
prevent catheter-related infections. Category IB
3.
Do not remove CVCs or PICCs on the basis of fever
alone. Use clinical judgment regarding the appropriateness of removing the
catheter if infection is evidenced elsewhere or if a noninfectious cause of
fever is suspected. Category II
¿Cada cuánto cambiar
los sets de administración?
De forma general, entre 4 y 7 días.
1. In patients not receiving blood, blood
products or fat emulsions, replace administration sets that are continuously
used, including secondary sets and add-on devices, no more frequently than at
96-hour intervals, but at least every 7 days. Category IA
Sistemas de administración de productos sanguíneos, o con
emulsiones grasas, a las 24 horas del inicio de la infusión.
2. Replace tubing used to administer blood,
blood products, or fat emulsions (those combined with amino acids and glucose
in a 3-in-1 admixture or infused separately) within 24 hours of initiating the
infusion. Category IB
Sistemas de administración de propofol, entre 6 y 12 horas o
al cambiar cada vial.
3. Replace tubing used to administer propofol
infusions every 6 or 12 hours, when the vial is changed, per the manufacturer’s
recommendation (FDA
website Medwatch
). Category IA
). Category IA
¿Y en los catéteres
arteriales?
Elegir preferentemente la arteria radial, braquial o pedia.
1. In adults, use of the radial, brachial or
dorsalis pedis sites is preferred over the femoral or axillary sites of
insertion to reduce the risk of infection. Category IB
Usar al menos gorro, mascarilla y guantes estériles con un
paño fenestrado para su canalización.
2. A minimum of a cap, mask, sterile gloves
and a small sterile fenestrated drape should be used during peripheral arterial
catheter insertion. Category IB
Retirar el catéter en cuanto no sea necesario. Y no
cambiarlos de forma rutinaria.
3. Remove the arterial catheter as soon as it
is no longer needed. Category II
4. Do not routinely replace arterial
catheters to prevent catheter-related infections. Category II
Cambiar los kits de monitorización cada 4 dias.
5. Replace disposable or reusable transducers
at 96-hour intervals. Replace other components of the system (including the
tubing, continuous-flush device, and flush solution) at the time the transducer
is replaced. Category IB
Desde este enlace
puedes descargar la guía completa, en la que se detallan todas las
recomendaciones anteriores, se profundiza en ellas y se recogen todas las
referencias que avalan estas y otras recomendaciones presentes en el texto.
