In 2012, acute care hospitals in the united states reported 30,100 central line associated bloodstream infections clabsis to the national healthcare safety network of the centers for. Central venous access is a common procedure performed in many clinical settings for a variety of indications. Central venous catheter care for the patient with cancer. Aseptic technique for accessing and changing needleless connector 4. A list of some of these problems, the causes, and what you should do about them is provided below. Methods and techniques used during central venous catheter insertion and management are critically important to preventing catheter associated blood stream infections or central line associated bacteraemia. Following five months with a sustained clabsi rate of zero per 1,000 catheter days, the acuity adaptable critical care unit at geisinger medical center in danville, pennsylvania, saw the clabsi rate spike to 3. Providing optimal care for patients with central catheters. There are many different types of central lines, and the care can vary depending on the line. Central line maintenance ghinwa dumyati, md university of rochester. Assuring rn competency in central line catheter care. You will need to watch for signs of infection, such as redness, swelling, pus, or a fever. Ahrq quality indicators toolkit obtain informed consent from patient to insert the central line and put the consent in the medical record.
Iv tubing is connected with a threaded lock cannula needleless system. The category of central line care and maintenance includes care of central lines and staff competencies related to these. Below you will find links to information about the different types of central lines and their care, as well as videos which explain how to safely care for your central line. Maintenance and removal of central venous catheters. Picc nursing protocol for the removal of central venous catheters following cardiothoracic surgery indications for central venous catheter removal include. M any types of central venous catheters are available. A broviac is a type of central line that allows for longterm access to blood. Various organizations provide guidelines on centralcatheter care. It is important that the reader know quinte healthcare corporation qhc policies on central venous access devices cvads and have successfully been certified on the care and maintenance of central lines before managing central lines independently. Apsic guide for prevention of central line associated bloodstream. Take extra care when removing clothing to avoid a pull or tug.
Scrubbing the hub central line care at home duration. American society of clinical oncology clinical practice guideline charles a. The central venous catheter or cvc is a bigger, longer catheter thats put into a large vein in the chest or upper arm. Twentysix out of the 34 studies analyzed presented significant results concerning decreased central line associated bloodstream infection rates after the implementation of care.
After fighting cancer alongside her daughter, a moms innovation improves quality of life for future patients. Central line care cincinnati childrens hospital medical center. Central lines are used to give fluids, medications, blood products, nutrition and to draw blood for labs. Central line packs products medline industries, inc. Nursing iv nursing board nursing notes central venous catheter central line oncology nursing iv therapy fundamentals of nursing nurse love in medicine, a central venous catheter is a catheter placed into a large vein in the neck, chest or groin. If you have questions about how to quality for and obtain free care, contact a mainehealth patient financial service representative today at 2078875100 or toll free at 8668042499.
These information sheets offer helpful guidance on how to care for a central line catheter. A hickman line is a soft, small, long, hollow tube that is placed into a vein in the chest and ends in a larger vein just above your heart. How to care for your central venous catheter cuffed and. Metrics the article champions for central line care september contains a discrepancy in the definition of central line associated bloodstream infections clabsis.
November 14, 2016 the clinical practice guideline on central venous catheter care for the patient with cancer was endorsed by the cog supportive care guideline committee in. Nursing protocol for the removal of central venous. Epidemiologic analysis of central lineassociated bloodstream infection clabsi first focused on intensive care unit icu patients. Utilise appropriate principles and guidelines in the care and maintenance of the. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous. See organizations with central catheter care guidelines by clicking the pdf icon above. Combative patients there are times when the critically ill patient requires a central line, but is combative due to issues such as hypoxia, cns injury or.
Catheter refers to the central venous catheter cvc. How to care for your central venous catheter cuffed and noncuffed the central venous catheter central line is a special intravenous catheter. Experts at primary childrens hospital created the content of this booklet to ensure you have the best and most complete information. It describes key evidencebased care components of the central line. If patient is stable and no potent iv drugs are required no indication for cvp measurement catheter related infection catheter exceeded recommend dwell time. A central venous catheter differs from an intravenous. Click here to download free teaching notes on central line central venous catheter. We conducted an interrupted timeseries study of a maintenance bundle concerning all areas of central line care. The investigators want to assess the feasibility of the use of a parafilm central line barrier parafilm as standard of care in pediatric hct patients. One of the most common but preventable hospitalacquired infections is a central line associated bloodstream infection clabsi, also known as a catheter related bloodstream infection.
Various organizations provide guidelines on central catheter care. Broviac care central lines a central line is a catheter, or soft flexible tube, that is placed into a large blood vessel near the center of the body. A central venous catheter, also called a central line, is a small flexible tube inserted into a large vein in your chest. The use of central venous catheters commonly referred to as central lines in out of hospital settings is very common as care is delivered to patients in their homes, in clinics, or in outpatient infusion centers. The institute for health care improvement ihi recommends bundling multiple practices to improve patient outcomes and prevent central line associated bloodstream infections clabsis. Preventing central line associated bloodstream infections. Nursing care of central venous catheters khacari mission. Central venous catheter hub cleaning prior to accessing centers for disease control and prevention cdc dialysis bloodstream. So in these patients you may still wish to reverse their coagulopathy prior to attempting a central line or consider placing the line under ultrasound guidance. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous therapies, for more reliable vascular access. Central venous catheter hub cleaning prior to accessing.
It is used to give you fluid, nutrients, medicine, and blood products. Your healthcare providers will teach you how to clean and care for the catheter site. Call tollfree 18006652850 central line iv catheter troubleshooting your central line catheter will not interfere with your daily activities if proper care is taken. Special care in cleaning and bandaging the skin at the catheter site can central venous catheter a central venous catheter katheter, also known as a central line or cvc, is long, soft, thin, hollow tube that is placed into a large vein blood vessel. This handout explains how we care for your central line while you are in the hospital, and how you can help.
Educate the patient and if needed, the family, about central line associated bloodstream infections. Caring for a central line at home danafarberboston childrens. Introduction of a dedicated clabsi team has been shown to be effective in the reduction of clabsi rates in the neonatal intensive care unit. Methods and techniques used during central venous catheter insertion and management are critically important to preventing catheterassociated blood stream infections or central line associated bacteraemia. Learn what to expect, tips to avoid problems, and when you should. A project to reduce the rate of central line associated. Although maintaining the central line requires special care, you can manage it within the comforts of your own home. The compliance rate to the central line bundle was 37% in 2008. Central venous catheters should be removed as soon as possible if they are not needed. August 1, 2018 a hickman is a central line catheter that is placed on the right side of your chest wall. Use cvcs with minimal number of ports or lumens needed to care for the patient. Always keep a clean and dry dressing over the central line site. Recommendations on prevention of intravascular catheter.
A regular iv catheter can only stay in for a few days, at most, so if you need to be treated over weeks or months, you will need many ivs. Nursing care of central venous catheters in adult intensive care. Clinical practice guideline on central venous catheter. It is also used to get blood samples without having to draw blood from your arm. See organizations with centralcatheter care guidelines by clicking the pdf icon above. Ii central line care central line care peripherally inserted central catheter picc one of the goals of intermountain healthcare is to ensure you feel comfortable caring for your child once you go home. Identify an rn who is caring for a patient with a central line. Central line associated bloodstream infections, clabsi, insertion bundle, maintenance bundle, quality improvement. The compliance was measured as the number of intensive care unit patients with a central line, for whom all four elements of the central line bundle are documented and in place divided by the total number of intensive care unit patients with central line. Wash your hands before doing any central line care and wear gloves. Central line insertion should be realtime ultrasound guided.
How to care for your central line danafarber cancer. Oct 23, 2014 stanford bmt nurses discuss care for central line catheters, also known as central venous access catheters. Change needle free devices every 7 days or as per manufacturers. Pdf medical officers handbook on central venous catheterization. Picc central line associated bloodstream infections clabsis result in thousands of deaths each year and billions of dollars in added costs to the u. The needle free connector needs to be changed weekly loveday et al 2014. Online iv continuing education course for nurses and health care professionals to provide knowledge to care for patients with central venous access devices cvad. Nursing protocol for the removal of central venous catheters following cardiothoracic surgery indications for central venous catheter removal include. Nursing care of central venous catheters in adult intensive care nswhealth statewide guidelines for intensive care. A hickman is a central line catheter that is placed on the right side of your chest wall. Central line associated bloodstream infection rate was effectively reduced from 3. Central venous catheter care and maintenance guideline draft heparin use requires a physicians order central venous catheter page 5 of 7 catheters catheter flushing dressing reflux valve cap blood withdrawal needed to clear line nicu. The dressing is changed on a central line when it is loose or saturated. Current education requirements are not effective in ensuring competency in central line care.
Each of 3 target groups clinic staff, homecare agency nurses, and patient families 1 received training on the bundle and its importance, 2 had their practice audited, and 3 were shown clabsi rates through graphs, inservice training, and bulletin boards. Which department are you completing this survey for. A global challenge, a global perspective the use of central venous catheters cvcs is an integral part of modern health care throughout the world, allowing for the administration of intravenous fluids, blood products, medications, and parenteral nutrition, as well as providing access for. Central line maintenance urmc university of rochester. Preventing central lineassociated bloodstream infections.
Central line catheters are used to take blood for tests and give fluids, nutrition, medicines, and blood products during treatment. More than 1,000 intensive care units across the country reduced clabsi rates by 41 percent when their clinical teams used the tools in this toolkit along with the core cusp toolkit. You will be taught how to prevent infections and other serious problems. Nursing care of central venous catheters date written. Recall nursing care required for nicu central lines an intravascular catheter that terminates at or close to the heart or in one of the great vessels which is used for infusion, withdrawal of blood, or hemodynamic monitoring the following are considered great vessels for the purpose of reporting central line bsi and counting central line days. Central line care peripherally inserted central catheter picc. Central lineassociated bloodstream infection clabsi is a term used by the. This study presents care measures to prevent central line associated bloodstream infections recently addressed among patients hospitalized in intensive care units. Pamela lopezvargas, kevan polkinghorne guidelines a. Central line care for adults seattle cancer care alliance. Full title nursing care of central venous catheters in adult intensive care short title cvc nursing guideline owner nsw health intensive care coordination and monitoring unit primary authors kaye rolls cnc iccmu judy currey rn phd guideline development group members judy currey chair gdn at icccdc mark mclennan cnc jeff breeding cnc.
View test prep central line quiz questions from iv therapy 101 at mt. Piccs are a reliable alternative to short term central venous catheters, with a lower risk of complications. The dressing is changed on a central line when it is loose or. Toolkit for reducing central lineassociated blood stream. The toolkit for reducing central line associated blood stream infections clabsi can help your unit implement evidencebased practices to reduce and, in many cases, eliminate clabsi. Follow the instructions for cleaning the cap and using sterile equipment. The institute for health care improvement ihi recommends bundling multiple practices to improve patient outcomes and prevent central lineassociated bloodstream infections clabsis.
Nh residents who receive care at memorial hospital andor other associated mainehealth physician practices may also qualify for free care. Objectives describe the etiology and patient risks of central line associated bloodstream infections clabsi explore common central line care and maintenance practices observed in acute care hospitals discuss strategies that can be utilized moving forward to focus on clabsi prevention. Central line ruislip gardens stations with stepfree access from the central line platforms to the street are shown with this symbol improvement works may affect your journey, particularly at weekends. Oct 14, 2015 hct patients are at high risk for clabsi due to multiple factors, including prolonged immune suppression and the need for longterm central venous access. Parafilm to prevent clabsi in pediatric patients undergoing hct. The care of central venous lines should always be carried out using a strict aseptic. Guidelines for the care and maintenance of a peripherally.
Central lines are not without risk, and there are a multitude of complications that are associated with their placement. All fluidsmedication infused via central lines must be on a pump. Many types of central venous catheters are available. Catheter site care is performed with chlorhexidine at dressing changes. Care and maintenance of central venous catheter devices. Highly permeable transparent, transparent polyurethane or gauze dressings are all appropriate for use on exit sites of central venous lines used in haemodialysis. Pdf on oct 15, 2015, tim spencer and others published medical officers. It was unacceptable to mike and kezia that the hospital did hot have a safe and consistent solution to the aftercare of their infant daughters picc line and central line. The opening paragraph of the article says that the centers for disease control and prevention cdc.
There are many ways to measure competency in the health care setting but few address the knowledge, skills and atti. Resources for patients and providers video resources for patients and families. A central line is a tube catheter that providers place in a large vein in your neck, chest, groin, or arm. If you have a central venous catheter, taking care of it the right away helps you avoid infection and keep the catheter working. Your childs medical condition requires himher to have a central line. Picc central catheter picc piccs are frequently used to obtain central venous access for patients in seconary and primary care. Cdc is providing guidelines and tools to the healthcare community to help end clabsis.