on the cusp stop bsi central line dressing change l.
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On the CUSP: STOP BSI Central Line Dressing Change. Terminology for Lines Included. Percutaneously placed central lines Tunneled lines Peripherally inserted central catheter Vascular Access devices * May not include hemodialysis catheters. . 2. Who Completes.

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terminology for lines included
Terminology for Lines Included
  • Percutaneously placed central lines
  • Tunneled lines
  • Peripherally inserted central catheter
  • Vascular Access devices

* May not include hemodialysis catheters.

2

who completes
Who Completes
  • Nursing Personnel who have demonstrated competency for central line dressing changes, including PICC teams and Nurse practitioners.
  • Medical personnel who have demonstrated competency including physicians and physician assistants.

3

frequency
Frequency
  • Once weekly if a transparent dressing is used
  • Every day if a gauze dressing is used while bleeding
  • Any time a dressing is no longer occlusive, damp or visibly soiled.

4

equipment needed
Transparent dressing or gauze

Mask for person applying dressing

Cone mask for patient

Skin prep

Tape if gauze dressing is used

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)

5

additional supplies that may be needed
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

6

procedure preparation
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.

Continued…

7

procedure sterilization
Procedure: Sterilization
  • Open Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70% swab and drop onto sterile field.
  • Open transparent dressing and drop onto sterile field.
  • Open skin prep and place on outer edge of sterile field.
  • 10. Don sterile gloves.

Continued…

8

procedure cleansing the site
Procedure: Cleansing the Site
  • Clean skin with Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70% swab.
  • Using friction or scrubbing motion to apply. Begin directly at the insertion site as you move swab outward in a circular motion to cover all areas without retracing the area already cleansed.
  • Allow Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70% swab to air dry completely.*
      • *If using povidone iodine, allow to remain on the skin for at least 2 minutes, or longer until dry.

9

preparing to place dressing
Preparing to Place Dressing
  • Designate one hand to be the unsterile hand and pick up the skin prep packet.
  • Remove skin prep pad with sterile hand.
  • Apply skin prep on outer perimeter of skin where dressing edge will touch patient.
  • *Do not put skin prep over the catheter insertion site or the immediate surrounding area. Allow to completely dry.
  • *Do not apply organic solvents (e.g., acetone or ether) to the skin before insertion of catheters or during dressing changes.

10

placing the dressing
Placing the Dressing
  • Using your sterile hand, apply transparent dressing per manufacturer recommendations.
  • Label the dressing with date, time and initials to identify when changed.
  • 19. Document the dressing change on the flow sheet per protocol if indicated.

11

other options
Other Options
  • Please see other infection prevention options under the infectious disease series for information on Chlorhexidine impregnated patches, antibiotic coated catheters etc.

12

references
References
  • Johns Hopkins Hospital, Vascular Access Device Policy (Adult)

http://safercare.s3.amazonaws.com/support_media/docs/clabsi/Appendix_H_Adult_VAD_Policy.pdf

  • MMWR Guidelines for the Prevention of Intravascular Catheter-Related Infections

http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf

13

learning objectives
Learning Objectives
  • Review the evidence and recommendations for central line maintenance

15

source of recommendations
Source of Recommendations
  • Centers for Disease Control
  • Society for Healthcare Epidemiology of America
  • Infectious Diseases Society of America

16

overview of recommendations
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

17

central line insertion
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

18

central line dressing change
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

19

central line dressing change20
Central Line Dressing Change

Frequency:

  • Transparent dressing
    • Every 7 days
    • PRN if damp, loosened, or soiled
  • Gauze dressing
    • Every 48 hours for routine use

20

replacement of iv administration sets
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

21

hang time for parenteral fluids
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

22

catheter hub cleansing
Catheter Hub Cleansing
  • Clean hub before accessing with Chlorhexidine or 70% alcohol
  • No formal recommendations regarding how long to cleanse hub

23

remove unnecessary lines
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

24

education
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

25

references26
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.

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