Evidence-based recommendations for insertion, maintenance, access and removal of central venous catheters to prevent CLABSI
What this guideline saysGMJ summary
This guideline provides 16 good practice statements and 25 evidence-based recommendations for preventing central line-associated bloodstream infection (CLABSI) and other infections in patients with central venous catheters (CVCs). It covers short- and long-term catheters in adults, adolescents, children and neonates across all health care settings, excluding haemodialysis catheters.
Key recommendations include using maximal sterile barrier precautions during insertion, alcohol-chlorhexidine (1% or 2%) for skin disinfection, antiseptic patches or dressings at the insertion site, subclavian over femoral or jugular sites when possible, and avoiding routine catheter replacement. The guideline emphasizes formal training in aseptic technique, hand hygiene according to the WHO “Five Moments”, daily inspection of insertion sites, and prompt removal of unnecessary catheters.
CLABSI rates can reach 44.6 per 1000 central line days in some low- and middle-income countries compared to 0.8 in high-income settings. Implementation of these evidence-based practices through multimodal improvement strategies can significantly reduce infection rates, mortality, length of stay and costs, which can reach US$ 46,000 per CLABSI case.
Key pointsfor clinicians
- Use maximal sterile barrier precautions (cap, mask, sterile gown, sterile gloves, sterile full body drape) for CVC insertion
- Use alcohol-chlorhexidine 1% or 2% for skin disinfection before insertion (not in neonates due to burn risk)
- Apply antiseptic patches or dressings (e.g. chlorhexidine-impregnated) at insertion sites in adults, adolescents and children
- Change CVC dressings every 3 days or more when using formal schedules; change if moistened or disrupted
- Change administration sets (tubing) every 7 days for routine IV fluids; change after administering total parenteral nutrition or lipid products
- Prefer subclavian vein insertion over jugular or femoral veins to reduce infection risk
- Use normal sterile saline for "lock-off" flushing over heparinized saline
- Do not routinely replace CVCs unless clinically indicated; inspect insertion sites daily and remove promptly when no longer essential
Summary of recommendations and good practice statementsextracted from the guideline
| Recommendation/Statement | Type | Population | Certainty |
|---|---|---|---|
| Formal training in CVC insertion, maintenance, access, replacement and removal | Good practice | All | NA |
| Hand hygiene per WHO "Five Moments" using alcohol-based hand rub | Good practice | All | NA |
| Chlorhexidine-containing body wash daily in critically ill patients | Conditional | Adults, adolescents, children | Low |
| Maximal sterile barrier precautions at insertion | Conditional | All | Very low |
| Alcohol-chlorhexidine 1-2% for skin disinfection at insertion | Conditional | Adults, adolescents, children | Low |
| Antiseptic patch/dressing at insertion site | Conditional | Adults, adolescents, children | Low |
| CVC dressing changes every 3+ days if using formal schedule | Conditional | All | Very low |
| Change administration sets every 7 days for routine IV fluids | Conditional | All | Low |
| Subclavian or jugular veins over femoral vein | Conditional | All | Low |
| Subclavian vein as preferred site over jugular | Conditional | All | Low |
| Do not routinely replace CVCs unless clinically indicated | Conditional | All | Very low |
| Use CVC practice bundles | Conditional | All | Very low |
What changed in this edition
- This is Part 2 of a series; Part 1 (2024) covered peripheral intravascular catheters (PIVCs, PICCs, PACs)
- Part 2 focuses specifically on centrally-inserted catheters for non-haemodialysis use; Part 3 on haemodialysis catheters may follow
- Developed using GRADE methodology with systematic reviews of evidence published through 2025
- Includes cost-effectiveness analyses for selected interventions (antiseptic-coated and antibiotic-impregnated catheters)
- Addresses COVID-19 pandemic impact, noting increased CLABSI rates during the pandemic in many settings
ApplicabilityGeorgia and the region
Georgia and neighbouring countries in the South Caucasus and Eastern Europe face significant challenges with health care-associated infections and antimicrobial resistance. The 2023–2024 WHO global survey found only 6% of countries met all minimum requirements for infection prevention and control programmes. These guidelines are directly applicable to Georgian health care facilities, though national programmes must assess baseline CLABSI surveillance capacity, availability of recommended products (alcohol-chlorhexidine, antiseptic dressings, ultrasound), training infrastructure, and costs. Implementation should prioritize basic measures (hand hygiene, aseptic technique, appropriate site selection, daily inspection, timely removal) before resource-intensive interventions (antiseptic-coated catheters). Establishing national CLABSI surveillance aligned with WHO definitions and integrating these recommendations into national IPC standards would support SDG target 3.d.2 on reducing antimicrobial-resistant bloodstream infections.
Questions this guideline answers
What is the preferred insertion site for central venous catheters?
The subclavian vein is preferred over the jugular vein for infection prevention (though it carries higher pneumothorax risk, reducible with training and ultrasound). Both subclavian and jugular sites are preferred over the femoral vein due to lower infection risk. Avoid subclavian in patients needing or likely to need haemodialysis due to stenosis risk.
How often should CVC dressings be changed?
If using a formal dressing change schedule, change dressings every 3 days or more (not more frequently). Always change dressings if they become moist, loose, or visibly soiled, regardless of schedule. Use a sterile technique for all dressing changes and inspect the insertion site daily for signs of infection.
Should we use antibiotic-impregnated or antiseptic-coated catheters?
Either standard or antiseptic-coated catheters can be used; antiseptic-coated are suggested for high-risk patients (immunocompromised, history of recurrent CLABSI). For antibiotic-impregnated catheters, use either type; reserve for specific high-risk situations due to cost and theoretical AMR concerns. Facilities with high CLABSI rates should first implement other recommendations (bundles, hand hygiene, site selection) before considering specialized catheters.
What antiseptic should be used for skin preparation before CVC insertion?
Use alcohol-chlorhexidine 1% or 2% (preferably ≥1%) for skin disinfection in adults, adolescents and children. Do not use chlorhexidine in neonates due to chemical burn risk. If alcohol-chlorhexidine is unavailable, alcohol-iodine provides an alternative. Always allow the antiseptic to dry for at least 30 seconds before insertion.
How often should central line administration sets (tubing) be changed?
Change administration sets every 7 days when administering routine IV fluids. Change administration sets after administering total parenteral nutrition or lipid products (reasonable interval within 24 hours). More frequent routine changes (every 2–4 days) are not recommended as they offer no infection prevention benefit and increase costs.
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2026 (Part 2)
- Replaces
- Part 1 (2024) covered peripheral catheters; this is the first edition specific to central venous catheters
- Status
- Current
- Published
- 2026-05-28
- Languages
- English
- Scope
- Prevention of central line-associated bloodstream infection (CLABSI) and other infections with short- and long-term central venous catheters (non-tunneled CVCs, tunneled CVCs, totally implantable devices) in adults, adolescents, children and neonates in all health care settings. Excludes haemodialysis catheters and extracorporeal membrane oxygenation catheters.
- Audience
- Clinicians (physicians, nurses, infection prevention and control professionals, allied health staff), hospital administrators, health care managers, policy-makers, and patients requiring central venous catheters
- Pages
- 152
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-012180-5
- Evidence
- GRADE methodology with systematic reviews of RCTs and non-randomized studies; 25 recommendations (conditional based on low to very low certainty evidence) and 16 good practice statements; evidence-to-decision framework considering effects, values, resources, cost-effectiveness, equity, acceptability and feasibility
- Next review
- Not specified; guideline update process described in section 7
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