TL10EO-3 Central Line Committee Minutes

November 30th, 20110830 hours, CVU Conf Rm.

Present: / Kathy Guy, RN, Director of Professional Resources; Carolyn Cusic, RN, CM 11th flr; Joan Strauch, RN, Infection Control; Melissa Schoot, RN, ICU; Jennifer Robertson, RN, Clinical Manager ICU; Jeff Oram-Smith, CMO; Rose Ann Moore (phone), RN, Director of Patient Care Services; Jeanne Fox, RN, PICC Services.
Agenda Items /

Discussion

/ Actions taken / Follow-up
  1. Policy
/ Blood culture Policy will go to IDPC in December for final approval. / Will start staff education in January.
  1. ICU Project
/ ICU project going well, staff very supportive. Several IJ dressings—often need to be changed prior to scheduled time because of drainage. Evidence based practice is a subclavian should be used before using jugular (CDC). / Will send evidence based articles from medical journals to Intensivist and ED physicians on use of jugular cath versus subclavian.
Will take to Infection Disease physicians issues on use of jugular cath in ED and radiology and the risk of infection—will ask to write letter to ED and Intensivist physicians. Will get CMOs signature on letter.
Will check if we can continue project in ICU. Will need approval for more FTEs in PICC before can roll out to rest of system. Will prepare cost report to show savings with continuing program. / Jeanne Fox
Joan Strauch
Kathy Guy
  1. Scrubs for PICC
/ Discussed new attire policy for proceduralist. The patient and nurse are gowned prior to insertion of PICC. Same procedure for insertion of central line. No evidence that PICC nurse would need to change into scrubs when entering hospital. If patient in double room, patient is moved to a single room prior to inserting PICC. / Do not need to have PICC nurse wear OR scrubs—no evidence to support this practice.
  1. CXR on admit
/ ED physicians do not want to do chest x-ray for patient with PICC in place when admitted to the ED. Need to check tip or see if catheter flipped. Best practice in the nation is to xray prior to using catheter. When patient comes in we do xray prior to using on inpatient units. Do we know how often migration occurs? Missed place line can erode the vein wall. Also down side to getting too many xrays; cost and exposure.
Rocky Mtn Cancer Center requesting we use the Solo PICC because it does not need to be flushed as often (once a day with saline). We use Cath Flow at PSF that require flush twice a day. Cath Flow literature states to use heparin to flush. Recommended flush with 2ml heparin. Is this Bard recommendation? If this is company recommendation then we need to flush with heparin.
Solo PICC does not have clamp at end. Valve in Solo at beginning of flush. What are other Centura facilities using? Whether Solo or Brad would still need to be flushed per recommendations. Solo cath cost $20. More than Cath Flow.
Do we need to re-educate staff on flush? To med/surg skills review?
Need to consider how used by outpatient—all flushing done at home. / Recommend create guidelines for when xray should be done before use if PICC i.e., patient complaint of pain, problem with flow, if giving chemo, tPA or cardiac med.
Will check Bard guidelines on flush. Will send Bard information out to members to review. / Kathy Guy
  1. PICC Data
/ 100 PICCs inserted in Oct; 61 PH and 39 at SF. NO ICU Infections.
Need to start tracking number of clots and what used to clear clot?