The need for a CVC should be reassessed daily, and unnecessary
catheters should be removed because the probability
of catheter-related infections increases with time. The risk
of infection with catheterization stays relatively low until
about the fifth to seventh days and then increases exponentially.
197 Several trials have studied scheduled replacement
of catheters over a guide wire or in a new site, but none of
these strategies were able to show an improved outcome.198
Optimal catheter insertion technique and maintenance can
minimize infectious risks, but the most efficacious maneuver
is to remove the CVC as soon as it is no longer required. The
need for central venous access should be reassessed again
before discharging the patient from the ICU because the discharge
procedure is often an opportune time to remove any
indwelling lines, including bladder catheters.