Best Practices for Aseptic Skin Preparation for IV Catheter Placement with Amanda M. Shelby

July 2025
In this VETgirl online veterinary continuing education blog, Amanda M. Shelby, RVT, VTS (Anesthesia & Analgesia) reviews current recommendations for aseptic skin preparation for intravenous (IV) catheter cannulation in veterinary patients. IV catheterization is a valuable veterinary technician skill which extends beyond the point of cannulation to include care and maintenance all of which are important for optimal patient care.

By Amanda M. Shelby, RVT, VTS (Anesthesia & Analgesia)
VETgirl Senior CE Specialist

Best Practices for Aseptic Skin Preparation for IV Catheter Placement

Likely, everyone has a personal preference when aseptically preparing the skin for IV catheter placement. It might be based on how you were trained, what you have seen done in practice, on consensus guidelines, or perhaps on peer-reviewed, literature. My short-term peripheral IV and intraarterial catheter site preparation technique is as follows (as seen in Figure 1):

1. Remove hair.

2. Wipe the catheter site with 70% isopropyl alcohol-soaked gauze to remove oils and organic debris.

3. Don examination gloves and scrub the area gently but deliberately with chlorhexidine 2-4%, non-diluted scrub for 30-120 seconds (depending on patient cooperation). The chlorhexidine is left in place for contact time during preparation of the catheter supplies (i.e., tape, open the catheter and flush the T-set with saline).

4. Remove the chlorhexidine scrub with 70% isopropyl alcohol gauze and place the catheter.

For peripheral central venous catheters (PICC) or jugular central line catheters, following aseptic preparation I don sterile gloves for the cannulation procedure (as aseptic technique is very important with these longer dwelling catheters!). Regardless of your method for skin preparation prior to cannulation, let’s review what the veterinary literature says on the topic?

Figure 1. Skin preparation for IV catheter placement. Video courtesy of Amanda M. Shelby

The American Animal Hospital Association (AAHA) provides us with the 2018 Infection Control, Prevention and Biosecurity (ICPB) Guidelines that address IV catheter placement and management procedures. AAHA suggests preparing a patient for peripheral, short term IV catheterization by removing hair, donning examination gloves and using chlorhexidine scrub diluted with saline to 0.5-2% solutions.¹ These guidelines do not remark on alternating between chlorhexidine (see Figure 2) and sterile saline or alcohol for the placement of peripheral IV catheters. Interestingly, isopropyl alcohol (see Figure 3) is not mentioned at all in the guidelines section for peripheral catheter management.

Figure 2 Chlorohexidine scrub. Photo courtesy of Amanda M. Shelby

Figure 3. Isopropyl alcohol placed in secondary container. Photo courtesy of Amanda M. Shelby

Does contact time matter?
Admittedly, I am attached to the concept of chlorhexidine’s need for skin contact time which is why I do not alternate between antiseptics with my above-described technique. But does contract time matter? The importance of contact time and the relationship between the degree of dilution and need for longer contact time has been documented whereby more dilute formulations of chlorhexidine require longer duration of contact with the skin to achieve similar disinfection.² AAHA’s ICPB guidelines reference one peer-reviewed, scientific study which looked at the effectiveness of chlorhexidine scrub dilutions and one compared to two scrubs decreased incidence of skin bacteria.³ The study concluded antiseptic efficacy was maintained in chlorhexidine gluconate diluted to 0.4% and that two scrubs were superior to one, as recommended by the manufacturer of the chlorhexidine gluconate scrub used. It is worth noting the scrubbing techniques used in this study did not the alternate between chlorhexidine scrub and alcohol (or saline) and these were surgical scrubs with appropriate contact time between first and second applications. A key take-away, is that antiseptic contact time and concentration matter and are specific to the agent used.

How do veterinary guidelines compare to human guidelines?
Evidence-based human guidelines for preventing IV catheter related infections recommend the following:
• Hand preparation involves washing hands with soap and water or use of alcohol-based hand rubs
• Donning clean examination gloves for peripheral IV catheters, sterile gloves for central, PICC and arterial catheters
• Use of >0.5% chlorhexidine with alcohol (70% alcohol or iodine-based solutions can be used when chlorhexidine is contraindicated)
• Allow antiseptics to completely dry before catheter insertion⁴

Interestingly, the human guidelines also have no mention of alternating between chlorhexidine (or other antiseptic) and alcohol, but they do specify alcohol, unlike the veterinary guidelines. However, like the veterinary guidelines, concentration and contact time specific to the aseptic used are still key take-aways.

Maintaining patency and prevention of catheter-related infections
Following placement, our focus transitions to maintaining patency and prevention of catheter-related infections. Catheter placement and care can impact the occurrence of phlebitis, catheter related infections, and increase risk of multidrug resistant bacteria.^5-6 Slight variations between the human and veterinary guidelines mentioned here exist but generally they agree on these principles:

• Inspect catheters regularly (2x day) for phlebitis, pain on injection, or swelling around the catheter (see Figure 4).
• Ensure tape and dressings are clean and dry; replace if damp or soiled.
• Use alcohol to disinfect the top of multidose vials before withdrawing solutions.
• Change needles before injecting solutions through a patient port (or use needless ports) and alcohol swab injection ports before injection.
• Change most fluid administration lines every 72 hours (human guidelines say no more frequently than 96 hours but at least every 7 days) except for total parenteral nutrition (TPN) which both agree, should be changed every 24 hours.^1,4

Figure 4. Limb swelling from IV catheter. Photo courtesy of Amanda M. Shelby

What about antibiotic or antiseptic ointments at catheter insertion sites?
One notable difference between the veterinary and human guidelines, notwithstanding species specific variations, is the use of antibiotic or antiseptic ointments at the catheter insertion sites. AAHA’s ICPB guidelines suggest povidone iodine ointment can be used at the site of entry while the human guidelines suggest avoiding this, except with dialysis catheters, due to the possible promotion of fungal and antimicrobial resistant infections.^1,4

While all this may seem tedious and at times confusing, due to the lack of evidence-based protocols in veterinary medicine, the principle is good nursing care with the mission to uphold best practices, ideally where scientific evidence is available, and continue to review common practices for improvement. Following consensus guidelines and reviewing their cited supporting references can be beneficial. Human guidelines, while an extrapolation, may be beneficial to review where veterinary studies are lacking or absent. The end goal is always to optimize patient care and minimize hospital acquired infections!

References:
1. Stull JW, Bjorvik E, Bub J, et al. 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines. J Am Anim Hosp Assoc 2018;54(6):297-326.
2. Stinner DJ, Krueger CA, Masini BD, Wenke JC. Time-dependent effect of chlorhexidine surgical prep. J Hosp Infect 2011;79(4):313-6.
3. Bajaj TI, Loh C, Borgstrom D. Diluting chlorhexidine gluconate: one scrub or two? Surg Infect (Larchmt) 2014;15(5):544-7.
4. O’Grady NP, Alexander M, Burns LA, et al. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):e162-93.
5. Crisi PE, De Santis F, Aste G, et al. Inflammatory, Mechanical and Infectious Complications Associated with Peripheral Intravenous Catheters in Dogs and Cats: A Risk Factor Analysis. Vet Sci 2022;6;9(3):118.
6. Simpson SE, Zersen KM. Incidence and type of peripheral intravenous catheter complications documented in hospitalised dogs. J Small Anim Pract 2023;64:130-135.

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