Central venous access device locking practices in the adult critical care setting: a single-centre, observational study establishing duration of locking per catheter lumen

Insertion of a central venous access device (CVAD) facilitates easy access to a patient's circulation, enables administration of irritant medications, parenteral nutrition, antibiotics, and facilitates frequent bloodwork. Central venous access is also used to deliver lifesaving measures including renal replacement therapy, extracorporeal membrane oxygenation, and rapid delivery of fluids during hypovolemic shock (O'Grady et al, 2011). As such, a CVAD is placed frequently among intensive care unit (ICU) patients. Although they are essential to care, complications such as central line infection and occlusion may develop. These complications may become life threatening and serve to increase morbidity and mortality of ICU patients (Ziegler et al, 2015). Preventing complications associated with central venous access is imperative to ensuring the best possible care for patients experiencing critical illness.

Many interventions to prevent complications, such as central line-associated bloodstream infection (CLABSI), catheter occlusion, and premature removal, have been implemented into ICU standards of care. Examples include the use of catheter insertion bundles and checklists (Lee et al, 2018), hub decontamination, or ‘scrub the hub’ procedures (Caspari et al, 2017), regular dressing changes and flushing (O'Grady et al, 2011), daily chlorhexidine bathing (Shah et al, 2016), quality improvement projects relating to adequate staff training (Coopersmith et al, 2002; Warren et al, 2004), and maintenance of appropriate staffing of units (Holder et al, 2020; Stone et al, 2008). Many modifications to catheters themselves are also available including silver impregnation and antibiotic coating (Lorente et al, 2016). Despite these efforts, CVAD complications remain a problem in the ICU setting. According to the Canadian Nosocomial Infection Surveillance Program, the rate of CLABSI was reported to be 1.2 per 1,000 catheter days in the adult mixed ICU in 2018 (Canadian Nosocomial Infection Surveillance Program1*, 2020). Recent changes to practice caused by the COVID-19 pandemic have been shown to increase rates of CLABSI by as much as 325% (Assi et al, 2021; LeRose et al, 2021).