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Central Line Education: Focus on CLABSI 2009

Central Line Education: Focus on CLABSI 2009. UC Campus Rates Comparison. Dressing Change Procedure. Steps of dressing change procedure. Open kit to Inner Level. Central Line Associated Blood Stream Infections (CLABSI).

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Central Line Education: Focus on CLABSI 2009

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  1. Central Line Education: Focus on CLABSI 2009

  2. UC Campus Rates Comparison

  3. Dressing Change Procedure • Steps of dressing change procedure

  4. Open kit to Inner Level

  5. Central Line Associated Blood Stream Infections (CLABSI) • Central line infections are associated with high morbidity, mortality, prolonged length of stay, and significant costs • Skin flora can colonize central lines and migrate along the catheter to the intravenous space. • Inflamed skin or wounds at the insertion site increase the risk for catheter associated colonization, biofilm formation, and infection.

  6. Current Challenges in Central Line Insertion Site Assessment • Nursing (RN) documentation options for describing line insertion site appearance do not offer a way to communicate problematic central line insertion sites • Physicians (MD) must open nursing documentation to see line insertion site assessments • RN and MD communication on concerning insertion site findings is inconsistent • Once symptomatic insertion site is identified, there is no directive on what actions should be taken

  7. Central Line Insertion Site Assessment (CLISA) Score • The CLISA score was developed to: • Improve the quality of insertion site documentation • Improve RN-MD communication of line site appearance • Facilitate early recognition of localized insertion site inflammation/wounds • Facilitate removal of high risk central lines

  8. CLISA Score 0: Normal appearance • Description: • The skin directly around the insertion site is flesh-colored. • There is no erythema, no localized swelling or drainage. • Actions: • RN documents CLISA Score 0 and serial assessments continue per usual.

  9. CLISA Score 1: Minimal Erythema • Description: • The skin directly around the insertion site has minimal erythema, < 3mm radius. • There is no focal swelling at the site • There is no purulence. If drainage or crusting is present, it is non-cloudy and serosanguineous. • Note: the catheter diameter of peripherally inserted or multi-lumen central venous catheters is almost 3mm. This can be used to gauge the size of the erythema. • Actions: • RN communicates with next shift • MD acknowledges the CLISA Score of 1 in the progress note.

  10. CLISA Score 2: Advancing Erythema • Description: • The skin directly around the insertion site has increased erythema, 3-6 mm radius. • There may be focal swelling at the site • There is no purulence. If drainage or crusting is present, it is non-cloudy and serosanguineous. • Note: the catheter diameter of peripherally inserted or multi-lumen central venous catheters is almost 3mm. Doubling this size can help gauge progression up to 6mm. • Actions: • RN verbally communicates with MD • CLISA 2 strongly consider line removal. If unable to remove, physician documents reason and plan

  11. CLISA Score 3: Severe Erythema or Purulence • Description: • The skin directly around the insertion site has rapidly worsening erythema, or is >6 mm radius. OR • There is any amount of purulence or cloudy crusting, with or without erythema. • Focal edema may accompany erythema • Note: the catheter diameter of peripherally inserted or multi-lumen central venous catheters is almost 3mm. Doubling this size can help gauge progression past 6mm. • Actions: • RN pages MD • CLISA 3 immediate line removal. If unable to remove, physician documents reason and plan.

  12. Additional Details • If skin around insertion site is not visible for any reason (e.g., gauze or excess blood making skin difficult to visualize), then the RN will document “NV = insertion site not visible”. • Findings of erythema or edema should relate solely to that which is organized around the insertion site. Clinical parameters of CLISA do not apply to generalized erythema or edema (as may be found in anasarca or acute thrombus). • Purulence can be present without erythema and may indicate a tunnel infection • Physicians have the option to change the CLISA score if their exam of the insertion site differs from nursing assessment • CLISA scoring will not apply to port-a-caths or the neonatal ICU

  13. EPIC Nursing Documentation Assess and document site according to policy

  14. CLABSI Rate UCI

  15. Summary Prevention is key. Optimize patient safety, remove lines at the earliest opportunity.

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