St. Luke’s University Health NetworkPage 1 of 4

Annual 2013

Adult Central Line Education

Directions for Completion of Education

  1. Read the Adult Central Line Education 2013, which begins on the next page of this document, before proceeding to the posttest.
  1. Once you have read and understand the information, exit the education page and complete the posttest which is final step of this education.

Remember, no attendance record is needed.

Completion of the posttest will be sent electronically to your EduTracker record once a 100% is achieved.

Print the Certificate of Completion for your records.

  1. If you have any questions about this information, please contact your manager or a member of the Device Associated Infection Performance Improvement Team.

Adult Central Line Education 2013

Objectives

  1. Identify elements for central line bundle compliance.
  2. Empower the observer to stop line insertion if any element of the central line insertion bundle is not followed.
  3. Identify strategies to prevent central line associated infections through proper maintenance and prompt removal.

SLUHN Data

Network Acute Care
Number
CY2009 / CY2010 / CY2011 / CY2012
SLB / 23 / 13 / 13 / 10
SLAC / 0 / 5 / 2 / 0
SLRA / 0 / 0
SLQ / 1 / 0 / 0 / 2
SLM / 0 / 0 / 0 / 0
SLW / 2 / 1 / 2 / 2
Total / 26 / 19 / 17 / 14
/ Network Critical Care
Number
CY2009 / CY2010 / CY2011 / CY2012
SLB / 8 / 5 / 5 / 5
SLAC / 1 / 1 / 0 / 1
SLRA / 0 / 2
SLQ / 0 / 0 / 0 / 0
SLM / 0 / 0 / 0 / 0
SLW / 0 / 2 / 1 / 0
Total / 9 / 8 / 6 / 8

Indications for Central Lines

  • Medications which require central line use
  • Hemodynamic monitoring
  • No peripheral access
  • Multiple ports needed
  • Home IV therapy (e.g. chemotherapy, TPN, antibiotics)
  • Treatment/therapy (e.g. hemodialysis, plasmapheresis)

Patient Education

  • Educate patients about necessity/risks of central lines using materials from Krames On-Demand™.
  • Remember to document patient education.

Central Line Insertion Bundle Elements

  • Appropriate hand hygiene.
  • Maximum barrier precautions.
  • Use of chlorhexidine skin preparation prior to insertion and allow the prep agent to dry per manufacturer’s instructionsprior to insertion.
  • Avoid using the femoral vein for central venous catheters in adult patients.
  • Daily review of line necessity with prompt removal of unnecessary lines.
  • Ensure an empowered observer is present during procedure. This observer must be empowered to stop the line insertion if any element of the central line insertion bundle is not followed!

Central Line Maintenance

  • Does the patient really need a central line??
  • Remember to ALWAYS assess and reassess the patient for ability to insert peripheral access.
  • Follow Network Daily Device Assessment Process
  • The prompt removal of unnecessary central lines is the most crucial element of patient safety
  • Hand hygiene before and after accessing a central line.
  • Use aseptic technique when accessing the line.
  • Scrub the hub with alcohol: vigorous scrub using twisting motion; allow alcohol to dry.
  • Change IV solutions and tubing per IV Therapy Policy.
  • Patients with TPN infusions may be at increased risk of infection. Please refer to “Parenteral Nutrition and Fat Emulsion” policy:
  • Each bag of TPN must not hang for more than 24 hours.
  • IV medications and fluids should not be infused through the same port/lumen that is being used to administer TPN.
  • Parenteral nutrition needs to run through a dedicated line or port/lumen of a multi-lumen device. With the exception of piggy-backed fat emulsions, no IV push or IV piggyback medications may be added to these lines.
  • TPN tubing change should occur every 24 hours.
  • Maintain dressings intact. Change dressings per policy and anytime the integrity of the dressing is compromised.
  • When changing dressings, please remember to wear a mask and sterile gloves for the procedure.
  • Address catheter occlusions promptly.

Documentation

  • For departments that do not document in Care Manager:
  • Receiving RN will ensure insertion form is completed and document in care manager.
  • Care Manager charting:
  • Insertion date, time, hour, and line type
  • Insertion bundle
  • Document patient education
  • “Line necessary” needs to be documented daily
  • Document date central line was discontinued

Please Note: Insertion date, time, hour and bundle should only be documented ONE time on day of insertion.

Completion of the Invasive Device Daily Assessment – Physician Order Form

  • RN completes:
  • Date
  • Time
  • Identifies Central Line Type
  • Central line day
  • Insertion date
  • Physician:
  • Continues or discontinues per indications
  • If continues, identifies reason(s) for continuing line
  • Signs, date and time on bottom of form
  • RN:
  • RN signs, dates and times bottom of form to verify order

This process is a collaborative effort to remove all unnecessary central lines and decrease the risk of infection associated with central lines.

For additional details, please refer to “Central Venous Access Devices – Care and Maintenance, Blood Collection & Removal of” policy.

CDC Guidelines: Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011