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Most guidelines on central venous access focus, for good reasons, on preventing central line–associated bloodstream infections (CLABSIs). The landmark Michigan Keystone project demonstrated that a 66% reduction in CLABSIs could be achieved by following a simple prevention checklist that included handwashing, full barrier precautions during catheter insertion, 2% chlorhexidine for skin disinfection, avoidance of femoral insertions, and prompt removal of catheters when no longer needed (N Engl J Med 2006; 355:2725). These new American Society of Anesthesiologists guidelines are unique in that they also address prevention and management of mechanical trauma related to central venous catheter insertion.
Key recommendations include the following:…