Central Line Maintenance

Central Line MaintenanceCentral Line 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.