Transcript Project Report - Lean Sigma

Central Line Maintenance
Learning Objectives
• Review the evidence and recommendations for
central line maintenance
Slide 2
Source of Recommendations
• Centers for Disease Control
• Society for Healthcare Epidemiology of America
• Infectious Diseases Society of America
Slide 3
Overview of Recommendations
Central line maintenance recommendations address
the following topics:
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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
Slide 4
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
Slide 5
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
Slide 6
Central Line Dressing Change
Frequency:
• Transparent dressing
– Every 7 days
– PRN if damp, loosened, or soiled
• Gauze dressing
– Every 48 hours for routine use
Slide 7
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
Slide 8
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
Slide 9
Catheter Hub Cleansing
• Clean hub before accessing with Chlorhexidine or
70% alcohol
• No formal recommendations regarding how long to
cleanse hub
Slide 10
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
Slide 11
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
Slide 12
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):S22S30.
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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.
Slide 13