Catheter line safety question

tryingtohaveitall · Nov 10, 2008

Have question on catheter infections and safety precautions used in various hospitals. My current employer in process of modifying. Specifically, have others used items like JnJ's biopatch in either ICU or general inpatient beds? In a large percentage of patients if so? thx in advance.
John

Yes, we've used the Biopatch for years on all central lines and PICCs. I don't have statistics but our infection rate is very low.

iluvivt, BSN, RN · Nov 10, 2008

Many hospitals began to change their policies when the CDC came out with their 2002 Recommendations to Prevent Catheter-Related Bloodstream Infections. It was back then that we made quite a few changes. We have a very proactive team. In October of this year catheter related bloodstream infection (CRBSI) was one of many events that will no longer be paid for by Medi-Care and thus the push and maybe panic for change. Sad that it the potential loss of $ that prompts the change for improved patient care. Please check out the CDC site for this document. Here are the big time changes hospitals are making or are continuing to do.

1. All CVCs including PICCs will be placed using maximal barrier precautions. This includes masks,gowns,gloves,large body drapes. We also limit room traffic and wear hair net.

2. The need for the CVC should be evaluated daily. This is particularly true for short term lines such as the percutaneously placed lines in the Jugular,Femoral and Subclavian sites. A PICC is more of an intermediate type line and unless patient has unexplained fever or elevated WBC these are evaluated,but can stay longer. We take out these short term lines and replace with PICC,if patient still requires access. This includes careful daily site assessment as well as looking at the overall current condition of the patient.

3. Use of Chorhexadine gluconate as the prep and for all catheter dressing changes.

4. CDC does not make a specific recommendation for use of a chlorhexadine patch at the site ,since it was so new at the time. Many hospitals have looked at the studies and agree it is worth it. In studies the Biopatch (chorhexadine disk) reduces CRBSI is reduced by 60%. That is huge!!!!!. The makers of Tegaderm (3M) has a new product with the Chlorhexadine already attached,in a clear gel type form,that you can apply all in one piece.

5. Perform all dressing changes and cap changes in an aseptic manner and on time and immediately change any compromised caps and dressing.

6. Scrub all caps well and maintain IV systems with the utmost of care. For example, change all tubing on time,WASH YOUR HANDS b/f working with any CVC ,flush per protocol,do not just leave occluded lumen (from blood) etc.

7. Infection control should be tracking all potential CRBSI,especially in ICUs.

8. Many hospitals have a nurse observer with a check list during CVC insertion,to monitor for breaks in technique and to monitor compliance.

Please check out the CDC site and the Instiute for Health Care Improvement (they have samples of check lists and outline some other practices hospitals can take)