Central Line associated BSI's

JeanOfAllTraits · Oct 20, 2013

We just have good old fashion hand hygiene, "scrub the hub" with an alcohol swab for 10-15 second when making connection and sterile technique for all dressing changes.

aprilfresh · Oct 25, 2013

I guess more specific questions might help. We currently do sterile dressing changes q 7 days unless moist/soiled with a standardized kit. Chloraprep for those greater than 2 months old, alcohol and betadine for those less than 2 months. We change our caps q 4 days in a sterile fashion (lipids are daily). What are other facilities doing?

We do return our blood waste to our patients, do other units do this?

When drawing labs from central lines do you have a standard procedure? If so, do you mind sharing it?

Do you utilize stopcocks for lab draws?

brithoover · Oct 25, 2013

Well we do dressing changes q7 and caps and tubing q4 as well. Lipids and all syringe lines q24. We try to minimize blood draws if possible clustering what needs done. Do not return blood waste. Do not use stopcocks.

brithoover · Oct 25, 2013

Blood draw: waste 3ml, take sample, flush cap with ns to get blood out, attach lines. Clamping line in between all of these steps and of course scrubbing the hub (:

Pediatric Critical Care Columnist · Oct 25, 2013

We follow sterile procedure for insertion of both CVLs and art lines. That means the doc sets up a sterile field for all supplies, scrubs, dons bouffant cap, mask, sterile gown and gloves, drapes the patient, uses a bucketful of Soluprep (regardless of age or weight) and applies the transparent dressing before taking down any of the drapes.

When accessing the line we create a mini sterile field with a 4x4, scrub the stopcock hub and change the dead-ender every time. Waste is 2-3 mL, depending on the line, and it's returned most of the time. Line changes are q 3 days for most infusions (nobody listens to the CDC here) except lipids and a couple others that are specified in our PPDM. Dressing changes are q 3 days unless there's gauze under it, then it's q day or as needed. We use Soluprep on everybody; we have no standardized kit so we have to collect a dressing tray, a handful of Soluprep swab sticks, a new Tegaderm IV dressing and anything else we might desire to use first. We don't use Biopatches although there are some on the central line cart. We've been told that the only lines we're EVER to put them on are femoral art lines, because "all of our CVLs are antimicrobial-impregnated and our arterial line catheters aren't".

We also don't use Interlink caps or Claves, the former because nobody bothered to inservice the staff when they were first acquired so people don't know they need to be primed before they're put on ports and there have been incidents of air in lines on ECMO patients. So we threw the baby out with the bathwater. We use MicroClaves on our ECMO circuits but not on our lines; our inpatient units and NICU, as well as the community hospitals and health centers, use them though. I haven't figured that one out yet.

marmstrong26 · Oct 25, 2013

We do sterile dressing changes q 7 days unless it is gross or wet. Chloraprep to clean and chlorahexidine impregnated dressings for those greater than 2 months old, alcohol and betadine with a biopatch for those less than 2 months. Lines are changed q4 days and we NEVER move anything from a peripheral line to a central line without stringing up a new line. We only return blood to lines that have heparin (like little kid art lines).

meanmaryjean, DNP, RN · Oct 26, 2013

We use the alcohol-impregnated caps on all ports/ stopcocks and unused microclaves. I will admit I was not a believer at first- but we have had ZERO BSIs for over a year now and there are several studies backing up our decision to implement them. In fact, our adult hospital just started using them based on our success.

The brand we use is EffectivCaps/

IVRUS, BSN, RN · Oct 28, 2013

Our dressings are changed q 7 days and prn, or q 48 hrs if a transparent sterile membrane wasn't used.

For instance, if gauze is needed because of allergies, or excessive diaphoresis, then the dressing is labeled a gauze dressing and changed q 48hrs.

Caps on Catheters that stay in over a week, (midlines, PICC's and MD placed central Lines) get changed q 7 days AND prn unless TPN or lipids are infusing, then we change the caps daily.

Retruning any blood when doing lab draws should only be performed IF the syringe does NOT become dissconnected from the patient. DO NOT RETURN THE BLOOD, if at any point you disconnect the syringe from the patient. Staying connected to draw labs, such as in the mixing method of obtaining labs, prevents anemia in some populations. But disconnecting and setting the syringe filled with blood aside to reinfuse it later is NEVER acceptable. You probably are doing it the right way, but I want to make sure that we are on the same page.

Stopcocks are a great source of bacterial contamination, and their use is discouraged.