Transcript Central line Bundle Education

Central line Bundle
Education
National Patient Safety Goal 07.04.01
2009
Something you should know!
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Central line associated bloodstream
infections can and do kill our
patients
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They are preventable!
Patients should not be harmed by the
care that is intended to help them.
A Central line is defined
As:
An intravascular catheter that terminates at
or close to the heart or in one of the great
vessels and is used for….
*Infusion (TPN, Dialysis, Meds, Blood)
*Withdrawal of blood
*Hemodynamic monitoring
Line Contamination Leading to
Bloodstream Infection
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Can occur at the time of insertion, during access of the line,
or even at dressing changes.
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The cost to the health care system is huge and CLABSI is
so preventable that reimbursement to treat it may be denied.
And while the cost to healthcare is high the cost to the
patient is IMMEASURABLE!
How to Prevent?
One of the National Patient Safety
Goals is to implement evidence-based
practices known to reduce the risk of
CLABSI
 To that end a grouping of best
practices known as the “Central Line
Bundle” has been created and is in
fact now being widely used throughout
the nation and locally.
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Here are The KEY Components
of the Bundle
Optimal line and site selection
 What will the line be used for and
how long will it be needed? PICC?
IJ? Subclavian?
 Femoral sites should be avoided due
to higher risk of infection and DVT
Hand Hygiene
Wash or Alcohol foam
 Before and after palpating catheter
insertion sites
 Immediately before donning sterile
gown and gloves at insertion
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Maximal Barrier Precautions
A mask, cap, sterile gown and gloves
must always be worn by the inserter.
 A mask and cap must always be worn
by all healthcare persons in the room
at the time of insertion.
 A full body drape must be used (head
to toe) and a sterile field maintained
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Skin Prep
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Chlorhexidine is the prep of choice, which means no
more betadine!
Apply the Chloraprep before draping, using back and
forth gentle friction for 30 seconds MINIMUM over the
immediate puncture site area ( check in with the clock
please) and then work in the same manner outward for
about 3” in all directions. DO NOT take the applicator
back over the puncture site once you leave it.
Allow to dry and do NOT wipe or blot
After insertion - immediate sterile application of
dressing
The Checklist
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Must be completed for EVERY line inserted.
If all bundle components are not followed
the checklist must reflect why.
Nursing has the power to stop the
procedure if sterility is compromised or if
components are missed ie: hand hygiene
not performed
In a life threatening situation where the
bundle may not be fully implemented a
checklist must still be completed with
patient sticker and reason not followed.
Central Line Insertion Checklist - sample
Patient Sticker
Date: __________
Location: _________
Inserter: ____________
Assistant: ____________
Safety Pause:
Site:
Line Type:
Barriers:
Hand
Hygiene:
(Foam or
Wash)
Prep:
Insertion
Barriers:
Dressing:
____ ID Patient
____ Emergent
____ Elective
____ Subclavian
____ Internal Jugular
____ Groin
____ Upper Extremity
____ Single Lumen
____ Double Lumen
____ Triple Lumen
____ Cordis
____ PICC
* ____ Education sheet given to
____ Dialysis
patient/family
____ Tunneled
____ Cap on Inserter
____ Mask on Inserter
Insertion Bundle:
____ Cap on Assistant
____ Mask on Assistant
____ Pre Gowning (Inserter)
____ Pre Gloving (Assistant)
____ Chloraprep
____ Minimum 30 seconds back and forth friction
____ Dry time (3 minutes) before insertion
____ Sterile Gown
____ Sterile Gloves
____ Full Body Drape
____ Applied immediately by inserter
Please send completed checklist to Quality __
Get it Out!
Daily review of line necessity and
prompt removal when no longer
needed.
 The longer the line is there the greater
the
risk.
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Must Do’s for Line
Accessing/Maintenance
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Firstly: You guessed it! Don’t touch that line
until you’ve washed/foamed your hands
Thoroughly scrub the tops AND threads of
connectors with alcohol before you access
them.
Visual inspection or palpation requires STERILE
gloves
Pain may indicate start of problems
Do’s cont’d
Anytime blood is drawn from the line
each lumen must then be flushed with
20-30ml normal saline
 A lack of blood return through any
lumen means an immediate need for
declotting with altaplase.
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Determination of a Central line
Associated Bloodstream
Infection
Criterion #1
A recognized pathogen from one or
more blood cultures and the organism
is not related to an infection at another
site
OR..
Criterion 2
Patient has at least one of the following symptoms:
 Fever (>38ºC), chills, or hypotension
and
 Symptoms are not related to infection at another site
and
 Common skin contaminant (Corynebacterium spp.,
Bacillus (not B.anthracis), Propionibacterium spp.,
coagulase-negative staphylococci, viridans group
streptococci, Aerococcus spp, Micrococcus spp)
is
cultured from two or more blood cultures drawn on
separate occasions
Dressing Change
The patient (unless intubated) and
healthcare provider should be masked
during the dressing change.
 Please thoroughly clean the site
including the line segment that will be
in the dressing and allow it to dry fully
before applying the new dressing
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Summary – key points
Meticulous hand hygiene
 An insertion checklist followed every
time
 Meticulous care of the line
 Get it out ASAP
 Document adherence to the bundle
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