Area	Recommendations
Educating, training, and staffing	Educate healthcare personnel regarding the indications for catheter use, proper procedures for the insertion and maintenance of catheters, and appropriate infection control measures.
	Periodically assess knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of catheters.
	Designate only trained personnel who demonstrate competence for the insertion and maintenance of catheters.
	Ensure appropriate nursing staff levels.
	Use initiatives in which multifaceted strategies are “bundled” together to improve compliance with evidence-based recommended practices.
Care of catheters and sites	Use an upper-extremity site for catheter insertion. Replace a catheter inserted in a lower extremity site to an upper extremity site as soon as possible.
	In pediatric patients, the upper or lower extremities or the scalp (in neonates or young infants) can be used as the catheter insertion site.
	Select catheters based on the intended purpose and duration of use, known infectious and non-infectious complications (e.g., phlebitis and infiltration), and experience of individual catheter operators.
	Use a midline catheter or peripherally inserted central catheter instead of a short peripheral catheter when the duration of intravenous therapy will likely exceed six days.
	Evaluate the catheter insertion site daily by palpation through the dressing to discern tenderness and by inspection if a transparent dressing is in use. Gauze and opaque dressings should not be removed if the patient has no clinical signs of infection. If the patient has local tenderness or other signs of possible thrombophlebitis, an opaque dressing should be removed, and the site inspected visually.
	Remove peripheral venous catheters if the patients develops signs of phlebitis (warmth, tenderness, erythema, or palpable venous cord), infection, or a malfunctioning catheter.
	There is no need to replace catheters more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults.
	Replace catheters in children only when clinically indicated.
	Remove any catheter that is not essential.
	Use a transparent, semi-permeable dressing to cover the catheter site.
	Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled.
	Do not use topical antibiotic ointment or creams on insertion sites.
	Encourage patients to report any changes in their catheter site or any new discomfort to their provider.
Hand hygiene and aseptic technique	Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs. Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing a catheter.
	Maintain aseptic technique for the insertion and care of catheters.
	Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, an iodophor or chlorhexidine gluconate) before catheter insertion.
	Antiseptics should be allowed to dry according to the manufacturer's recommendation prior to placing the catheter.
	Wear clean gloves, rather than sterile gloves, for the insertion of catheters, if the access site is not touched after the application of skin antiseptics.
	Wear either clean or sterile gloves when changing the catheter site dressing.
	When adherence to aseptic technique cannot be ensured (i.e., catheters inserted during a medical emergency), replace the catheter as soon as possible (i.e., within 48 hours).