You are caring for four clients who are receiving IV infusions of normal saline. Which client is at the highest risk for bloodstream infections?
A. A client who has nontunneled central line in the left internal jugular vein.
B. A client with an implanted port in the right subclavian vein.
C. A client with a peripherally inserted central catheter (PICC) line in the right upper arm.
D. A client who has a midline IV catheter in the left antecubital fossa.
Correct Answer: A. A client who has a non-tunneled central line in the left internal jugular vein.
Several factors increase the risk for infection for this client: central lines are associated with a higher infection risk, the skin of the neck and chest having a high number of microorganisms, and the line is tunneled. The concern that physicians have with non-tunneled catheters is that they have a short duration of use. Because of this, they should be removed as soon as possible in order to prevent complications like infections or thrombosis.
Option B: Implanted ports are placed under the skin and so are less likely to be associated with catheter infection than a non-tunneled central IV line. For long-term use, implanted ports are preferred as they have better cosmetic results and less infection as compared to non-tunneled catheters and tunneled catheters.
Option C: PICC lines can remain inserted for weeks to months. They are indicated in situations where the patient needs an intravenous delivery of antibiotics or chemotherapy drugs while preserving the integrity of the peripheral vascular system.
Option D: Peripherally inserted IV lines such as midline catheters and PICC lines are associated with a lower incidence of infection. A peripherally inserted central catheter or a PICC line is a thin, flexible tube that is inserted into an upper arm vein and then guided into the superior vena cava on the right side of the heart.