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Central Line Maintenance. Learning Objectives. Review the evidence and recommendations for central line maintenance. Source of Recommendations. Centers for Disease Control Society for Healthcare Epidemiology of America Infectious Diseases Society of America. Overview of Recommendations.
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Learning Objectives • Review the evidence and recommendations for central line maintenance
Source of Recommendations • Centers for Disease Control • Society for Healthcare Epidemiology of America • Infectious Diseases Society of America
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 • Education
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
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
Central Line Dressing Change Frequency: • Transparent dressing • Every 7 days • PRN if damp, loosened, or soiled • Gauze dressing • Every 48 hours for routine use
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
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
Catheter Hub Cleansing • Clean hub before accessing with Chlorhexidine or 70% alcohol • No formal recommendations regarding how long to cleanse hub
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
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
References • 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.