on the cusp: stop bsi central line dressing change
DESCRIPTION
On the CUSP: STOP BSI Central Line Dressing Change. Terminology for Lines Included. Percutaneously placed central lines Tunneled lines Peripherally inserted central catheter Vascular Access devices * May not include hemodialysis catheters. 2. Who Completes. - PowerPoint PPT PresentationTRANSCRIPT
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On the CUSP: STOP BSI On the CUSP: STOP BSI Central Line Dressing ChangeCentral Line Dressing Change
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Terminology for Lines IncludedTerminology for Lines Included
• Percutaneously placed central lines
• Tunneled lines
• Peripherally inserted central catheter
• Vascular Access devices
* May not include hemodialysis catheters.
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Who CompletesWho Completes
• Nursing Personnel who have demonstrated competency for central line dressing changes, including PICC teams and Nurse practitioners.
• Medical personnel who have demonstrated competency including physicians and physician assistants.
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FrequencyFrequency
• Once weekly if a transparent dressing is used
• Every day if a gauze dressing is used while bleeding
• Any time a dressing is no longer occlusive, damp or visibly soiled.
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Equipment NeededEquipment Needed
• Chlorhexidine Gluconate 2% w/ Isopropyl Alcohol 70% (1 Swab)*
– * do not use if patient is sensitiveTincture of iodine or 70% isopropyl alcoholmay be used.– *do not use chlorhexidine in patients<2 years old.
• Sterile Gloves (appropriate size)
• Clean Gloves (appropriate size)
• Transparent dressing or gauze
• Mask for person applying dressing
• Cone mask for patient
• Skin prep
• Tape if gauze dressing is used
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Additional Supplies that Additional Supplies that May Be NeededMay Be Needed
• Sterile cotton tipped applicator (needed to cleanse insertion site)
• Sterile cup to hold sterile saline
• Sterile normal saline
• Adhesive removal pads or alcohol wipes
• Sterile 2x2 gauze
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Procedure: Preparation Procedure: Preparation 1. Explain procedure to patient/family.
2. Wash your hands.
3. Don clean gloves and remove old dressing using alcohol swab or adhesive remover pads as needed.
4. Inspect insertion site of catheter for signs of infection. Culture if needed. Assess security of sutures.
5. Remove your gloves.
6. Open sterile gloves and create a sterile field using sterile glove package.
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Procedure: SterilizationProcedure: Sterilization
7. Open Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70% swab and drop onto sterile field.
8. Open transparent dressing and drop onto sterile field.
9. Open skin prep and place on outer edge of sterile field.
10. Don sterile gloves.
Continued…
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Procedure: Cleansing the SiteProcedure: Cleansing the Site
11. Clean skin with Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70% swab.
12. Using friction or scrubbing motion to apply. Begin directly at the insertion site as you move swab outward in a circular motion to cover all areas without retracing the area already cleansed.
13. Allow Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70% swab to air dry completely.* *If using povidone iodine, allow to remain on the skin for at least 2 minutes, or longer until dry.
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Preparing to Place DressingPreparing to Place Dressing
14. Designate one hand to be the unsterile hand and pick up the skin prep packet.
15. Remove skin prep pad with sterile hand.
16. Apply skin prep on outer perimeter of skin where dressing edge will touch patient.
*Do not put skin prep over the catheter insertion site or the immediate surrounding area. Allow to completely dry.
*Do not apply organic solvents (e.g., acetone or ether) to the skin before insertion of catheters or during dressing changes.
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Placing the DressingPlacing the Dressing
17. Using your sterile hand, apply transparent dressing per manufacturer recommendations.
18. Label the dressing with date, time and initials to identify when changed.
19. Document the dressing change on the flow sheet per protocol if indicated.
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Other OptionsOther Options
• Please see other infection prevention options under the infectious disease series for information on Chlorhexidine impregnated patches, antibiotic coated catheters etc.
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ReferencesReferences
• Johns Hopkins Hospital, Vascular Access Device Policy (Adult)
http://safercare.s3.amazonaws.com/support_media/docs/clabsi/Appendix_H_Adult_VAD_Policy.pdf
• MMWR Guidelines for the Prevention of Intravascular Catheter-Related Infections
http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf
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On the CUSP: STOP BSI Central On the CUSP: STOP BSI Central Line MaintenanceLine Maintenance
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Learning ObjectivesLearning Objectives
• Review the evidence and recommendations for central line maintenance
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Source of RecommendationsSource of Recommendations
• Centers for Disease Control
• Society for Healthcare Epidemiology of America
• Infectious Diseases Society of America
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Overview of RecommendationsOverview 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
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Central Line InsertionCentral 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
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Central Line Dressing Central Line Dressing ChangeChange
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
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Central Line Dressing Central Line Dressing ChangeChange
Frequency:
• Transparent dressing– Every 7 days– PRN if damp, loosened, or soiled
• Gauze dressing– Every 48 hours for routine use
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Replacement of IV Administration Replacement of IV Administration SetsSets
• 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
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Hang Time for Parenteral Hang Time for Parenteral FluidsFluids
• 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
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Catheter Hub CleansingCatheter Hub Cleansing
• Clean hub before accessing with Chlorhexidine or 70% alcohol
• No formal recommendations regarding how long to cleanse hub
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Remove Unnecessary LinesRemove 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
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EducationEducation
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
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ReferencesReferences
• Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control and Hospital Epidemiology. 2008; 29 (supp. 1):S22-S30.
• O’Grady NP, Alexander M, Dellinger P, et al. Guidelines for the prevention of intravascular catheter-related infections. Infection Control and Hospital Epidemiology. 2002; 23(12):759-769.
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