High Risk Central Lines

Presentation adapted from APIC 2014 Convention “3024: High Risk Central Lines:

What Else Can We Do?”

Multiple catheters and/or multiple lumens Emergency insertion Prolonged duration of CVC Prolonged hospital stay prior to CVC insertion Excessive manipulation of the catheter Neutropenia Prematurity Total parenteral nutrition

Source: CDPH “CLABSI Prevention” presentation

CLABSI Risk Factors

Insertion Bundle Maintenance Bundle

Full body drape Hand hygiene Max barrier: sterile

gown, gloves, mask and cap

CHG prep, SCRUB CHG sponge at site Monitor compliance to

bundle Needleless adaptor on

all lumens Anyone can call

“STOP”

Daily assessment of continued need

Hand Hygiene Scrub the hub – 15 sec

(LET IT DRY!) Clean, intact,

occlusive dressing Change tubing per

policy Evaluate lumen

patency Minimize access ->

group activities Flush per policy

After implementation of CLABSI bundles (insertion and maintenance): Who was still getting infections? ◦ Non- ICU patients ◦ Long term lines◦ Oncology patients◦ Varied insertion sites ◦ Short-gut kids

At Multi-Care Health System, Washington (5 hospitals)

Development of a High-Risk Algorithm – find them before they are infected!

Decisions/Interventions

Daily baths with chlorohexidine wipes (start at central line site and work out, then chin to toes)

Daily linen changes All central line tubing is to be secured in

upward direction to prevent touching of things such as surgical wounds, ostomies, diarrhea (i.e. added infection risk sources)

High Risk Bundle – Adults

Protect femoral line from diarrhea. Dress line in specific manner to help prevent IV tubing and line from coming in contact with diarrhea (i.e. larger dressings, skin protectants, etc…)

If central line dressing requires reinforcing, dressing needs to be changed

Discuss with MD the implementation of ethanol lock or antibiotic lock (depending on central line catheter material – ethanol not compatible with polyurethane, ok with silicone. Contact IVT for help/intervention).

High Risk Bundle – Adults