Central Line Education for Medical Staff and their Allied

Health Providers (AHP)Revised June 2012

The information in this self-pace education presentation is intended to re fresh and / or bring new information to you regarding techniques to use to prevent Blood Stream Infections (BSI).

Some pertain to hospital staff while others pertain to anyone involved in the care of a

patient.

National Patient Safety Goal (NPSG) 07.04.01 - Implement evidence-

based practices to prevent central line-associated bloodstream infections. Note: Involves short and long term central venous

catheters and peripherally inserted central catheter (PICC) lines.

Care of Central Venous Catheters

• Central Line dressing change will be done per Nursing policy #200.048

• Transparent central venous catheter dressing changes and maintenance will be used throughout the hospital.

• Licensed nurses who have demonstrated competency in completing this skill may change central venous catheter dressings.

Care of Central Venous Catheters

• The insertion site for central venous catheters shall be assessed by ETMC Staff each shift for signs and symptoms of infection and documented on the nursing flow sheet.

• Transparent central venous catheter dressings will be changed using sterile technique every Friday or sooner if the integrity of the dressing is in question.

Care of Central Venous Catheters

• Integrity of the transparent dressing is in question if:

• ANY part or corner of the dressing that is not completely adhered to the patient’s skin or there is blood, dried or fresh, and/or drainage/fluid observed underneath the dressing, or if the BioPatch is saturated with blood, dried or fresh, and/or drainage/fluid is observed or the patient is diaphoretic and dressing appears to be loose.

Care of Central Venous Catheters

• If date of last dressing change is missing then the integrity of the dressing is in question and must be changed as soon as possible with the current date, time and initials of licensed nurse.

• Femoral line dressings may need to be changed more frequently due to a higher risk of dressing integrity and contamination.

Care of Central Venous Catheters

• All central line dressing will be changed on Friday of each week.

• No matter when the line was placed the dressing will be changed the following Friday.

• eg. The line was placed on Wednesday; then the dressing will be changed 2 days later on Friday and then every Friday as long as the integrity of the dressing stays intact.

BSI Prevention (Claves/Connectors)

• Replace clave/connectors every time the tubing is changed which is every Monday and Friday or as needed depending on type of fluids and labeled

-If line is “Saline Locked” then change claves/connectors at the same time as the dressing is changed which is every Friday.

-Some tubing may need to be changed more frequently like TPN (daily) or Diprivan (every 12 hours).

BSI Prevention (Claves/Connectors and flushing)

• Scrub each port with alcohol prep pad for 15 seconds.

• Aspirate to confirm blood return and then flush using a turbulent motion.

• Flush each port with 10cc of preservative free normal saline.

• Flush each port with 20cc of preservative free normal saline after all blood draws and TPN.

• Each line will be flushed every 8 hours.

BSI Prevention

• Preventing BSI’s (Blood Stream Infections) starts when the catheter is inserted.

• Nurses are responsible for observing catheter insertion and maintenance to ensure proper technique is used at all times.

• All central lines should be performed in a sterile manner with strict attention to aseptic technique.

BSI Prevention• TIME OUT must be completed

prior to the start of the procedure:

a. Is the consent signed, dated, timed and correct?

b. Is this the correct patient?c. Is there a documented reason for the procedure?d. Have all the supplies been collected?e. Everyone in the room has on a mask and head cover?f. Clinician and Assistant are wearing sterile gloves, gown with mask and head cover?f. Everyone present and agree on procedure?

BSI Prevention

• Place sign outside of room.

• DO NOT ENTER

BSI Prevention

BSI Prevention

• Maximal Barrier Drape to be used on all central line insertions.

• MD to wear sterile hat, gown, mask and gloves.

• Everyone else in the room must wear hat and mask.

• Anyone assisting with the procedure must wear sterile hat, gown, mask and gloves.

BSI Prevention• Chlorhexadine – is an

antiseptic solution that kills germs and bacteria on contact by gently scrubbing the area with a back and forth motion.

• Due to the combination of alcohol and chlorhexidine with fast action and persistence, ETMC has adopted it as being their primary antiseptic to prevent bloodstream infections.

• Chlorhexidine continues to be active on the skin surface for at least 48 hours.

BSI Prevention

• Daily, review all IV sites to remove lines as soon as possible to prevent potential complications.

• This includes peripheral as well as central lines.

BSI Prevention

• Anchoring Lines• Make sure catheters

are properly anchored.

• Loose catheters may slide back and forth, increasing the risk of infection.

BSI Prevention• After viewing the following power point the

Physician or AHP will need to complete the appropriate parts of the checklist and turn it into the Medical Staff Office for filing in your QI credential file .

• Yearly, upon hire or job responsibility change, education about how to prevent blood stream infections is a requirement at ETMC.

East Texas Medical Center - Tyler

Completion Verification

for

Central Line Blood Stream Infection and Prevention Education

 

 

I _____________________ certify that I have reviewed the power point presentation titled "Central Line Blood Stream Infection and Prevention" for CY 2013.

 

 

 Signature and Title: ______________________ Date____________