TABLE 4

Guidelines for the Prevention of Intravascular Catheter-related Infections

1. Remove and do not replace umbilical artery catheters if any signs of central line–associated bloodstream infection, vascular insufficiency in the lower extremities, or thrombosis are present (Category II).
2. Remove and do not replace umbilical venous catheters if any signs of central line–associated bloodstream infection or thrombosis are present (Category II).
3. Cleanse the umbilical insertion site with an antiseptic before catheter insertion. Avoid tincture of iodine because of the potential effect on the neonatal thyroid. Other iodine-containing products (eg, povidone-iodine) can be used (Category IB).
4. Do not use topical antibiotic ointment or creams on catheter insertion sites because of the potential to promote fungal infections and antimicrobial resistance (Category IA).
5. Add low doses of heparin (0.25–1.0 U/mL) to the fluid infused through umbilical arterial catheter (Category IB).
6. Remove umbilical catheters as soon as possible when no longer needed or when any sign of vascular insufficiency to the lower extremities is observed. Optimally, umbilical artery catheters should not be left in place for more than 5 d (Category II).
7. Umbilical venous catheters should be removed as soon as possible when no longer needed but can be used up to 14 d if managed aseptically (Category II).
8. An umbilical catheter may be replaced if it is malfunctioning and there is no other indication for catheter removal and the total duration of catheterization has not exceeded 5 d for an umbilical artery catheter or 14 d for an umbilical vein catheter (Category II).