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Gauze and opaque dressings should not be removed if the patient has no clinical signs of infection.

Evaluate the catheter insertion site daily by palpation through the dressing to discern tenderness and by inspection if a transparent dressing is in use.

Use a midline catheter or peripherally inserted central catheter (PICC), instead of a short peripheral catheter, when the duration of IV therapy will likely exceed six days.

Avoid the use of steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs.

Select catheters on the basis of the intended purpose and duration of use, known infectious and non-infectious complications (e.g., phlebitis and infiltration), and experience of individual catheter operators.

In pediatric patients, the upper or lower extremities or the scalp (in neonates or young infants) can be used as the catheter insertion site.

Replace a catheter inserted in a lower extremity site to an upper extremity site as soon as possible.

In adults, use an upper-extremity site for catheter insertion.

Peripheral catheters and midline catheters Observational studies suggest that a higher proportion of “pool nurses” or an elevated patient–to-nurse ratio is associated with CRBSI in ICUs where nurses are managing patients with CVCs.

Ensure appropriate nursing staff levels in ICUs.

Designate only trained personnel who demonstrate competence for the insertion and maintenance of peripheral and central intravascular catheters.

Periodically assess knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of intravascular catheters.

Educate healthcare personnel regarding the indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters, and appropriate infection control measures to prevent intravascular catheter-related infections.

The renumbering does not constitute change to the intent of the recommendations. Edit: An * indicates recommendations that were renumbered for clarity.