certification of central venous lines georgia health sciences medical center augusta, georgia...

Certification of Central Venous Lines

Georgia Health Sciences Medical Center

Augusta, Georgia

November 13, 2012

The Joint Commission

National Patient Safety Goal #72010

“Reduce the risk of healthcare associated infections”

NPSG.07.04.01

Implement best practice or evidence based guidelines to prevent central line associated

bloodstream infections.

Elements of the Central Line Bundle:

Hand hygiene

Maximal barrier precautions upon insertion

Chlorhexidine skin antisepsis

Optimal catheter site selection, with avoidance of using the femoral vein for central venous access in adult patients

Daily review of line necessity, with prompt removal of unnecessary lines

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What is a “Certified Line”?

Inserted by a “Qualified Inserter”

Witnessed by a “Qualified Observer” Having at least 2 people present at all times during the insertion

procedure.

Verified by the “Qualified Observer” through documentation in the medical record that: All components of the CVL Bundle were followed, and

No breaks in sterile/aseptic technique occurred

Documented as “certified” in the medical record by the “Qualified Observer” All components of the bundle must be followed with no breaks in

sterile/aseptic technique.

NOTE: If components of the “bundle” are not adhered to, documentation by the “Qualified Inserter” indicates appropriate reason deviation occurred and can still be certified.

“Certified Line”=

“Qualified Inserter”+

“Qualified Observer”

(A non-certified line should be removed within 24 hours of insertion.)

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Who is a “Qualified Inserter”?

A Physician, PA or Advanced Practice RN who has met these two criteria:

Successfully checked off by their service as competent in the insertion of central lines and credentialed for CVL insertion

Successfully demonstrated competent use of the CVL Bundle by attending the CVL Bundle Program sponsored by Hospital Epidemiology

Who is a “Qualified Observer”:

Vascular Access Teams (AVAT/PVAT)Pediatric and Adult ICUsGeneral Nursing Units

Registered Nurses in:Interventional Radiology

Emergency DepartmentOperating Rooms (circulating nurses)Critical Care Units Pediatric Units

13 members24/7 Coverage

Preferred first contact for central line insertion observation

Routine maintenance for all central lines

Insertion of PICC lines

Adult Vascular Access Team - AVAT

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Pediatric Vascular Access Team-PVAT

8 PVAT membersCMC Coverage

Preferred first contact for central line insertion observation

Routine maintenance for all central lines

Insertion of PICC lines

Computerized Physician Order Entry(CPOE) Activates the VATs

CPOE Continued

CVL Bundle Program

Consists of: 1 hour didactic class

National Patient Safety Goals Central Line Bundle Hospital Policy Policy access on the intranet Basic Asepsis within surgical field

Competency demonstration in a simulated lab Skills assessed:

Surgical scrub / Donning sterile attire Skin prep / draping / Central Line Bundle Dressing & antimicrobial disc application Documentation of insertion and bundle Access to policies/procedures on line

CVL Bundle Program

Upon successful completion of the program a badge is given to identify them as a “Qualified Inserter”

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Next Step

Incorporate “Qualified Inserter” verification into the Procedure Time Out process and documentation using the “red” Asepsis (CVL Bundle) Program badge.