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E N D Presentation Transcript Learning Objectives • Review the evidence and recommendations for central line maintenance Source of Recommendations • Centers for Disease Control • Society for Healthcare Epidemiology of America • Infectious Diseases Society of America 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 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 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 Central Line Dressing Change Frequency: • Transparent dressing • Every 7 days • PRN if damp, loosened, or soiled • Gauze dressing • Every 48 hours for routine use 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 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 Catheter Hub Cleansing • Clean hub before accessing with Chlorhexidine or 70% alcohol • No formal recommendations regarding how long to cleanse hub 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 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 References • Marschall J, Mermel LA, Classen D, et al
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