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Student Programs Coordnator, GCM
PREVENTION OF
CENTRAL LINE-ASSOCIATED
BLOODSTREAM INFECTIONS
(CLABSI)
Corporate CLABSI Preventon Team
Target Audence: A heathcare workers nsertng or managng centra
nes.
Course Navigation
Course Navigation

Advance through the course usng the
navgaton bar on the bottom of the screen.
| ust cck the forward button (shown below)
Ob|ectves

Know the defnton of a centra ne catheter

Identfy the cassfcatons and types of centra ne catheters

Dscuss rsk factors and sources of centra ne assocated

boodstream nfectons (CLABSI)

Understand management of centra nes durng and after

nserton

Identfy cnca sgns and symptoms of centra ne

assocated boodstream nfecton (CLABSI)

Descrbe nterventons desgned to prevent centra ne

assocated boodstream nfectons. (CLABSI)
Terms

BSI - boodstream nfecton

CDC = Centers for Dsease Contro &

Epdemoogy

CHG - chorhexdne

CVC = centra venous catheter

CLABSI = centra ne assocated

boodstream nfecton
Genera Informaton

48% of ICU patients have central venous catheters

(CVCs), accountng for 15 mon CVC-days per year n
ICUs.

The CDC estmates the attrbutabe treatment costs

assocated wth a boodstream nfecton range from
$35,000 to $5,000!infection and ncrease ength of
stay by an average of " #ays.

>250,000 CVC-reated nfectons per year.

Mortaty may be up to 35%.

CDC. Gudenes for the preventon of ntravascuar catheter-reated nfectons. MMWR 2002;51(No. RR-10).

How do centra nes cause
boodstream nfectons?

Centra venous catheters (CVCs) dsrupt

the ntegrty of the skn aowng bactera
and/or fung to enter.

Infecton can spread to the boodstream

(bacterema)

Hemodynamc changes and organ

dysfuncton (sepss) may ensue.
CLABSI Defnton

A CLABSI s a prmary boodstream nfecton (BSI)

n a patent that had a centra ne within the 48-hour
perod before the deveopment of the BSI.

For the Infecton Preventonst to cassfy a CLABSI,

natonay accepted crtera from the CDC shoud be
met.
What s a centra ne?

An ntravascuar catheter that termnates at or cose to the

heart or
n one of the great vesses. Ths ne s used for nfuson,
wthdrawa
of bood, or hemodynamc montorng.

Great Vesses ncude:

Aorta

Superor vena cava

Inferor vena cava

Brachocephac ven

Interna |uguar ven

Subcavan ven

Pumonary artery

Externa ac ven

Common femora ven

In Neonates count, Umbca Ven

Note: nserton ste and/or type of devce does not defne a centra ne.
The foowng cassfy as Centra
Lnes
(may not be a ncusve) . . .

Subcavan, Femora or Interna | uguar (snge,

doube, trpe or quad)

Introducer |Cords|

Swan Ganz catheter

PICC

Hemodayss Vas-Caths (tunneed and non-

tunneed)

Impanted ports (.e., Port-a-caths)

Umbca (UVC)
Sources of CLABSIs

Mgraton of skn organsms at the nserton ste

nto the cutaneous catheter tract wth
coonzaton of the catheter tp s the most
common route of nfecton.

Contamnaton of the catheter hub aso

contrbutes to ntraumna coonzaton of ong-
term catheters.

Rarey, contamnaton of the nfused fud eads

to nfecton.
Pathogeness
Cnca Features of Lne
Sepss

Nonspecific

Fever

Chs, shakng rgor

Hypotenson, shock

Hyperventaton

Gastrontestna

abdomna pan

Vomtng

Darrhea

Neuroogc

confuson

sezures

Highly Suggestive of Line

Sepsis

Source of sepss unapparent

Patent unkey canddate for

sepss

Intravascuar ne n pace (or

recenty n pace)

Infammaton or puruence at
ste

Abrupt onset, wth shock

Sepss response to
antmcroba therapy or
dramatc mprovement after
remova of devce
What can we do to prevent a
CLABSI?
$atient!%a&ily '#ucation
$rior to Central (ine Insertion

Ensure the patent (and famy as needed) are

educated about centra ne nfecton preventon
pror to the procedure beng performed.

Document the educaton on the patents medca

record.

Patent educaton fyer can be obtaned by gong

to the Novant Heath Intranet PATIENT EDUCATION
SITE ))$*+I',+
I,-+.UC+I/,- ))-$'CI%IC %*CI(I+0(I'-) ))I,%'C+I/,
C/,+./(
))-$'CI%IC $*+I',+ I,-+.UC+I/, 1/CU2',+ I,
*($3*4'+IC*( /.1'.
Centra Lne Bunde
Compance

The centra ne bunde s a group of evi#ence 5ase# interventions for

patents wth ntravascuar centra catheters that, when mpemented
together, resut n better outcomes than when mpemented
ndvduay.

The scence behnd the bunde s so we estabshed that t shoud be

consdered standard of care.

Key Components:
1. hand hygene
2. maxma barrer precautons (both for the patent and the nserter)
when pacng a centra ne
3. chorhexdne skn antsepss
4. optma catheter ste seecton (subcavan preferred ste)
5. day assessment of ne necessty wth prompt remova of
unnecessary ne
Pror to Inserton
Demand Strct Hand Hygene
Observe proper hand washng procedures ether wth
conventona antseptc-contanng soap and water or
wth acoho-based hand rub.
Inserton:

The person nsertng the centra ne

shoud:
Seect an optma catheter ste, wth
subcavan ven as the preferred ste for non-
tunneed catheters n aduts (f not
contrandcated).
Inserton:
Head cover
Mask
Sterile Gown
Sterile Gloves
The person
nsertng & those
assstng
shoud don
maxma barrer
precautons.
Maxma Patent Barrer:

Drape the patient with the full body drape (head-to-toe).

Mantan a Stere Fed
Durng the Inserton:
Inserton:
The person nsertng the centra ne
shoud:
Use chorhexdne skn prep n a back-and-forth frcton
scrub.

For the so-caed dry stes (subcavan or |uguar), prep

for at east 30 seconds - aowng a 30 secon# #ry
ti&e6

For the wet stes (fe&oral or 7roin), prep for at east 8

&inutes 9ith a : &inute #ry ti&e.

Ensure that souton dres competey before attemptng

to nsert the centra ne.
Chorhexdne Aert . . .
Chlorhe;i#ine shoul# not 5e use# on<

Infants ess than 2 months of age

(unless approved by your facility)
or

Anyone wth a chorhexdne senstvty or

aergy.

For those meetng the above aerts, 10% povdone-

odne or 70% acoho may be used as an aternatve
skn prep.

If nsertng an umbca centra ne, avod tncture of

odne because of the potenta effect on the neonata
thyrod. Other odne-contanng products (e.g.,
povdone-odne) can be used.
After Inta Inserton

Appy occusve stere dressng per your

factys pocy.

Use exstng order set (f avaabe) or obtan MD

order for a chest x-ray to verfy centra ne
catheter tp pacement.

No fuds/medcatons shoud be admnstered

va the ne unt verfcaton of pacement s done
uness n an emergent stuaton.

After pacement has been verfed

Connect ,'= admnstraton sets and fuds to

ports

,'V'. connect prevousy used IV tubng to the

new centra venous access ne.
Documentaton on the Bunde
Compance Too
The ! or personnel assistin"
the physician # inserter with the
procedure will co$plete the
Central Line Procedural
Checklist (either electronically
or $anually% dependin" on the
availability at your facility).
Central Line Procedural Checklist

Insertion Date: ____/____/____ Time: _________ Unit Location Where Inserted: _____________

Inserter Name: Last:_______________________ First:_________________

Patient education given rior to insertion!

Line insertion "as #check one$: %mergent Non&emergent

Central line catheter t'e: Non&tunneled Central (enous Catheter #i!e!) Trile Lumen$
Tunneled Central (enous Catheter #i!e!) *ickman) +roviac) Neostar) ,roshong$
PICC
*emodial'sis #circle one$: tunneled non&tunneled
Introducer / Cordis
Imlanta-le orts #i!e) Port&a&cath$
."an,an/
Um-ilical

Num-er o0 lumens #circle one$: 1 2 3 4 Not alica-le

.ite o0 C(C Insertion: .u-clavian 5ugular Femoral Um-ilical Uer e6tremit'

I0 0emoral site used) state reason: ______________________________________________________________

Before the procedure, did the inserter:
Per0orm hand hygiene 7es No
Drae atient "ith large full body drape 7es No
Pre the site "ith CHG8 7es No
I0 no or contraindicated) state reason: _____________________________________________________

During the procedure, did the inserter use:
Sterile gloves 7es No
Sterile gown 7es No
Head cover 7es No
Mask 7es No


Did all personnel assisting* "ith the rocedure use:
Sterile gloves 7es No
Sterile gown 7es No
Head cover 7es No
Mask 7es No
#9ssisting : an'one lacing hands on the atient "hile the sterile 0ull -od' drae is on the atient or
an'one handing sterile sulies to the inserter!$

.ignature o0 erson comleting 0orm:_______________________________ Date:___________________





PATIENT Label
!"#!$ H%&$H
Central &ine 'rocedural Checklist
Lne Necessty

Day revew of centra ne necessty may prevent

deays n removng nes that are no onger needed.

Many tmes, centra nes reman n pace smpy

because of ther reabe access and because
personne have not consdered removng the ne.

However, t s cear that the rsk of nfecton ncreases

over tme as the ne remans n pace and that the rsk
of nfecton s decreased f removed.
Day Revew of Lne
Necessty

Every day, ask the foowng:

Does the patent st need the ne?

If yes, can a ess rsky catheter be used? (e.g., trpe umen to a perphera)?

If no, can we remove the ne today?

* central line &ay 5e consi#ere# necessary for the follo9in7:

ong-term antbotcs,

mutpe IV antbotcs,

mutpe bood / bood products,

vescant drugs (Dopamne, Dantn, Vancomycn) or rrtant drugs

(Cefoxtn, Fortaz),

TPN,

chemotherapy,

hemodynamc montorng,

reabe access (IV fud therapy, frequent bood draws, pan management).
Day Revew of Lne
Necessty

C%!$(& &)!% !%C%SS)$* + D)&* (%#)%,-
Goal- $o reduce central line associated infections and other co.plications

Insertion Unit Location#s$: _____________

To -e comleted -' ;N caring 0or the atient dail' 0or as long as the line is in lace!
;evie" line necessit' dail' and check aroriate -o6!

central line .ay be considered necessary for the following: #1$ long&term anti-iotics) #2$ multile I(
anti-iotics) #3$ multile -lood / -lood roducts) #4$ vesicant drugs #Doamine) Dilantin) (ancom'cin$ or irritant drugs
#Ce0o6itin) Forta/$) #<$ TPN) #=$ chemothera') #>$ hemod'namic monitoring) #?$ relia-le access #I( 0luid thera')
0re@uent -lood dra"s) ain management$!

Date (! )nitials *%S
Line continues
to -e
necessar'!
)f yes, list
the reason
nu.ber/s0
fro. above1
!"
Line is not
necessar' A can
-e discontinued!











DBT% C%NT;BL LIN% ;%CD(%D or atient discharge #"hich ever comes 0irst$: _____ / _____ / _____



!"#!$ H%&$H
Central &ine !ecessity
PATIENT Label
Daily% the ! is to
docu$ent the line&s
necessity on the Central
Line Necessity / Daily
Review tool.
Dressng Changes

Repace catheter-ste dressng f t becomes

damp, oosened, or vsby soed or when
nspecton of the ste s necessary.

Dressng changes are to be done based on your

factys pocy and ne type.

Chorhexdne s the preferred ceansng agent.

When ceansng the dressng ste, use
chorhexdne (CHG) swab or other approved
agents per your factys pocy.
Dressng Changes (contnued)

Do not use topca antbotc ontment or creams

on nserton stes (except dayss catheters).

Do not submerge the catheters under water.

Vsuay nspect ste for sweng, erythema or

dranage. If any of these symptoms are present
notfy physcan.

Do not use acetone or adhesve remover to

remove od dressngs.

Transparent dressng matera w reease when

stretched.
Admnstraton Sets

Repace admnstraton sets, ncudng secondary sets &

add-on devces, no more frequenty than at 72-hour
ntervas, uness CLABSI s suspected or documented.

Excepton: Admnstraton sets that have been

ntermttenty dsconnected from the patent (open
system) sha be changed every 24 hours and
mmedatey upon suspected contamnaton or when
the ntegrty of the product or system has been
compromsed.

Repace tubng used to gve bood/bood products after

each unt of bood/bood product s gven.
Provde optma care for
IV In|ecton Ports

Pror to accessng the port, cean t

per the manufacturers gudenes
(:0 t9ists 9ith "0% alcohol) and
aow to ar dry before accessng the
system. (No bowng or fannng).

Cap a centra ne ports when not n

use.

Change caps no more frequenty than

every 72 hours and at east every 7
days or accordng to the
manufacturers recommendatons.
'>C'$+I/,< Chan7e the cap 9hen: t has been removed for any reason or any
tme the cap appears damaged, s eakng, bood s seen n the catheter wthout
expanaton, bood resdue n the cap or when cap has been ad down on a non-
stere surface.
Hemodayss Catheters
Do not use hemodayss catheters for bood drawng or
appcatons other than hemodayss except durng
dayss, under emergency crcumstances or wth MD
order.

Use povdone-odne antseptc

ontment at the hemodayss
catheter ext ste after catheter
nserton and at the end of each
dayss sesson ony f ths ontment
does not nteract wth the matera of
the Hemodayss catheter per
manufacturers recommendaton.
References

http://www.cdc.gov/nhsn/PDFs/pscManua/4P
SC_CLABScurrent.pdf

http://www.h.org/IHI/Programs/Campagn/Ce
ntraLneInfecton.htm

CDC. Gudenes for the preventon of

ntravascuar catheter-reated nfectons.
MMWR 2002;51(No. RR-10)
You have now completed
You have now completed
Prevention of CLABSI
Prevention of CLABSI
CON!AT"LATIONS#
CON!AT"LATIONS#
Please continue to the test instructions on the next slide
$ow to !eceive Credit
To receive credit for thi% module &ou mu%t complete the te%t' To
complete the te%t( clic) the Ta)e Te%t lin) in the menu on the left
%ide of the %creen *pictured here+'
This will automatically launch the test. This will automatically launch the test.
Post Test
1. The CDC estimates the attributable treatment costs associated with a
bloodstream infection range from $35,000 to $56,000/infection and increase length of
sta b an a!erage of " das. #Circle one)
True or ,al%e'
$. % C&%'() is a *rimar bloodstream infection #'()+ in a *atient that had a central
line within the ,-.hour *eriod before the de!elo*ment of the '(). #Circle one)
True or ,al%e
3. % central line is an intra!ascular catheter that terminates at or close to the heart or
in one of the smaller *eri*heral !essels. #Circle one)
True or ,al%e
,. /hich of the following classif as a central line0
a' Subclavian( ,emoral or Internal -u.ular *%in.le( double( triple or /uad+
b' Introducer 0 Cordi%
c' Swan an1 catheter
d' PICC
e' $emodial&%i% 2a%3Cath% *tunneled and non3tunneled+
f' Implanted Port% *i'e'( Port3a3cath%+
.' "mbilical *"2C+
h' All of the above
Post test (Contd)
5' (ources of central line infections are1
a' 4i.ration of %)in or.ani%m% at the in%ertion %ite into the cutaneou% catheter tract'
b'Contamination of the catheter hub'
c' Contamination of the infu%ed fluid'
d' All of the above
6' The central line bundle is a grou* of e!idence based inter!entions for *atients with
intra!ascular central catheters that, when im*lemented together, result in better outcomes than
when im*lemented indi!iduall. Circle one
True or ,al%e
". 2e com*onents of the e!idence based central line insertion chec3list includes1
a' hand h&.iene
b' ma5imal barrier precaution% *both for the patient and the in%erter+ when placin. a central line
c' chlorhe5idine %)in anti%ep%i%
d' optimal catheter %ite %election *%ubclavian preferred %ite in an adult+
e' dail& a%%e%%ment of line nece%%it& with prompt removal of unnece%%ar& line
f' All of the above
-. 4rior to the insertion of the central line the *atient should be1
a' Educated about the central line and how to prevent infection'
b' 6raped with a full bod& drape *head to toe+'
c' iven a pair of %terile .love%'
d' All of the above'
e' A and B
Answer Key
1. True
2. True
3. Fase
4. H
5. D
6. True
7. Fase
8. E