Learning Objectives. Review the evidence and recommendations for central line maintenance. 2. Terminology for Lines Included. Percutaneously placed central linesTunneled lines Peripherally inserted central catheterVascular Access devices* May not include hemodialysis catheters. . 3. Source of R
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1. David A. Thompson DNSc, MS, RN
Central Line Maintenance/ Dressing Change
2. Learning Objectives
Review the evidence and recommendations for central line maintenance
3. Terminology for Lines Included Percutaneously placed central lines
Peripherally inserted central catheter
Vascular Access devices
* May not include hemodialysis catheters.
4. Source of Recommendations
Centers for Disease Control
Society for Healthcare Epidemiology of America
Infectious Diseases Society of America
5. Overview of Recommendations Central line maintenance recommendations address the following topics:
Central line insertion
Central line dressing changes
Replacement of IV administration sets
Hang time for parenteral fluids
Catheter hub cleansing
Removal of unnecessary lines
6. Central Line Insertion Ensure use of checklist
Empower nurses to stop the procedure if the steps in the checklist are not followed
Leadership must create a culture that supports nurses
7. Central Line Dressing Change Dressing change responsibility includes only those who have demonstrated competency:
Nursing personnel including PICC teams and nurse practitioners
Medical personnel including physicians and physician assistants
8. Frequency of Central Line Dressing Change Frequency:
Every 7 days
PRN if damp, loosened, or soiled
Every 24 hours for routine use
9. Equipment Needed Chlorhexidine Gluconate 2% w/ Isopropyl Alcohol 70% (1 Swab)*
* do not use if patient is sensitive
Tincture of iodine or 70% isopropyl alcohol
may be used.
*do not use chlorhexidine in patients
<2 years old.
Sterile Gloves (appropriate size)
Clean Gloves (appropriate size) Transparent dressing or gauze
Mask for person applying dressing
Cone mask for patient
Tape if gauze dressing is used
10. Additional Supplies that May Be Needed Sterile cotton tipped applicator (needed to cleanse insertion site)
Sterile cup to hold sterile saline
Sterile normal saline
Adhesive removal pads or alcohol wipes
Sterile 2x2 gauze
11. Procedure: Preparation Explain procedure to patient/family.
Wash your hands.
Don clean gloves and remove old dressing using alcohol swab or adhesive remover pads as needed.
Inspect insertion site of catheter for signs of infection. Culture if needed. Assess security of sutures.
Remove your gloves.
Open sterile gloves and create a sterile field using sterile glove package.
12. Procedure: Sterilization
13. Procedure: Cleansing the Site
14. Preparing to Place Dressing
15. Placing the Dressing
16. Replacement of IV Administration Sets
Lipids and blood products (enhance bacterial growth)
Change every 24 hours
All other IV administration sets
No more frequently than every 72 hours
Not more than every 96 hours
17. Hang Time for Parenteral Fluids
Lipid-containing parenteral nutrition
Change every 24 hours
All other IV fluids including nonlipid-containing parenteral nutrition
No formal recommendations
JHH changes nonlipid-containing IV fluids every 24 hours
18. Catheter Hub Cleansing
Clean hub before accessing with Chlorhexidine or 70% alcohol
No formal recommendations regarding how long to cleanse hub
19. Remove Unnecessary Lines
Assess need for continued central line access during daily multidisciplinary rounds
Add question to a Daily Goals worksheet
Complete every day during rounds
20. Education Educate all necessary staff:
Guidelines to prevent catheter-related bloodstream infections
Use of central line checklist
Proper insertion and maintenance of central lines
Ensure competency through yearly education and examination
21. WALK THE PROCESS When there is an infection...
22. Identify Barriers
about knowledge of prevention recommendations
what is difficult about doing these behaviors
Walk the process of staff placing a central line
Observe staff placing central line
23. Audit Your Process Patient Level
Was the check list used?
Was the protocol followed?
Did everyone wear appropriate clothing?
Did someone speak up?
Was the dressing secured?
Was the site cleaned and maintained per protocol?
Did you use a preferred site for placement?
Did the line stay in longer than needed?
24. Audit Your Process Unit Level
% of femoral lines versus IJ and SC?
% of time the check list is used?
% of time the protocol is followed?
% of lines that should have been removed?
How many nurses are comfortable speaking up? Did they?
IS there support for the all the staff?
Are lines changed out after emergent placement?
Femoral preferred for renal caths because of sclerosis but not at risk if place IJ. Femoral preferred for renal caths because of sclerosis but not at risk if place IJ.
25. Review of tool Audit tool for Maintenance
Johns Hopkins Hospital, Vascular Access Device Policy (Adult)
MMWR Guidelines for the Prevention of Intravascular Catheter-Related Infections
Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control and Hospital Epidemiology. 2008; 29 (supp. 1):S22-S30.
O’Grady NP, Alexander M, Dellinger P, et al. Guidelines for the prevention of intravascular catheter-related infections. Infection Control and Hospital Epidemiology. 2002; 23(12):759-769.