Which of the following is an evidence-based guideline for routine care of a central venous catheter (CVC) to prevent complications such as infection and occlusion?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

Scrubbing the hub with an appropriate antiseptic (like alcohol or chlorhexidine) for at least 15 seconds is a cornerstone of preventing central line-associated bloodstream infections (CLABSI).
This practice, known as 'Scrub the Hub,' uses mechanical friction to remove microorganisms and biofilm from the needleless connector before access.
Adherence to this simple step significantly reduces the risk of introducing bacteria into the bloodstream.
Guidelines recommend a scrub time ranging from 5 to 60 seconds depending on the device and antiseptic used; 15 seconds is a commonly accepted minimum.

Option A: Needleless connectors must be changed immediately if they are contaminated with blood or debris, or if their integrity is compromised. Changing them only at a set interval 'regardless of contamination' is an unsafe practice.
Option B: Chlorhexidine gluconate (CHG) greater than 0.5% with alcohol is the preferred antiseptic for CVC site care due to its superior effectiveness and residual activity in preventing infections.
Option D: Standard guidelines recommend changing transparent dressings every 5 to 7 days. Changing them more frequently, like every 72 hours, is unnecessary if the dressing is clean, dry, and intact, and may increase infection risk by exposing the site more often.

Clinical Relevance

Nursing practice connection: Knowing Evidence-based practices for Central Venous Catheter (CVC) care and prevention of Central Line-Associated Bloodstream Infections (CLABSI) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
CLABSI is a serious, costly, and preventable hospital-acquired infection with high morbidity and mortality. Strict adherence to CVC care bundles, including scrubbing the hub, is a critical nursing responsibility.
Nurses are the last line of defense against CLABSI. Diligent assessment of the CVC site, dressing, and lines during every shift is essential for early detection of complications.
What if? If a patient with a CVC develops a new fever and chills, the nurse must immediately assess the CVC insertion site for signs of infection (redness, swelling, tenderness, purulence), notify the provider, and anticipate orders for blood cultures from both the CVC and a peripheral site to investigate the line as a potential source.

How to Approach the Question

First, identify the core of the question: it asks for a correct, evidence-based guideline for routine CVC care.
Evaluate each option against standard infection control principles for intravascular devices.
Option A includes 'regardless of contamination,' which is a major safety red flag. Contaminated equipment is never ignored.
Option B suggests povidone-iodine. Recall or determine the preferred antiseptic for CVC care. Chlorhexidine (CHG) is generally recommended over povidone-iodine.
Option C describes 'Scrub the Hub.' This is a widely promoted, evidence-based practice. The time frame (at least 15 seconds) is a key detail consistent with guidelines.
Option D gives a specific time frame (72 hours) for transparent dressing changes. Compare this to the standard recommendation, which is typically longer (5-7 days).

Concept Tested & Keywords

Concept Tested: Evidence-based practices for Central Venous Catheter (CVC) care and prevention of Central Line-Associated Bloodstream Infections (CLABSI).
Stem keywords: central venous catheter, CVC, routine care, prevent complications, infection, occlusion
Lead-in keywords: Which of the following
Negative lead-in flag: false

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E6 Nursing Fundamentals Taylor pp. 802-804, 822-824, 801-803

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