Central lines and CLABSI

[johnsonmich990]

I work at a large hospital where we have had a few clabsi's in our Neonates. We are obviously looking decrease our clabsi rates system wide, but are focusing big time on our most vulnerable population. What do you use for central line dressings? Especially umbilical? Any policies (two nurses for sterile line change etc) that you employ specifically to decrease or prevent clabsi.

[BrandNewBabyNurse]

We have a lengthy 2-RN sterile line change procedure that we implement when we do a full change out every 72 hours, or whenever setting up a new central line. We also do a full line change every 24 hours on our micro preemies less than 1000 grams. For umbilical lines we usually just throw a tegaderm over the umbilicus and a loop of the catheter, although we typically never get to a sterile dressing change before the lines are removed or transitioned to a PICC if central access is still needed. We've also started using stopcocks on our larger bore PICCs and Broviac's lately to prevent having to break the central line for lab draws, and so far that has been going quite well.

[jennylee321]

We have a lengthy 2-RN sterile line change procedure that we implement when we do a full change out every 72 hours, or whenever setting up a new central line. We also do a full line change every 24 hours on our micro preemies less than 1000 grams. For umbilical lines we usually just throw a tegaderm over the umbilicus and a loop of the catheter, although we typically never get to a sterile dressing change before the lines are removed or transitioned to a PICC if central access is still needed. We've also started using stopcocks on our larger bore PICCs and Broviac's lately to prevent having to break the central line for lab draws, and so far that has been going quite well.

Interesting, what's the rationale for Q24H changes on micro prems?

[NicuGal, MSN, RN]

Don't your umbilicus sites get goooy with tegsdermon them? We have zero umbilical infections, for about 10 years now. We leave ours open to air, and just loop it to the side. Lines are changed every 96 hours.

For CVL and PICCs, sterile dressing changes every 7 days unless needed sooner.

Tubing changes for all lines except lipids and a few meds are every 96 hours, sterile. IL are every 24.

We had tubing especially made for our unit that has an integrated med line and three piggytails. We use the one with the filter as our main line, one is a med line that has a flush bag attached so the line is only broken when changing med syringes, and the other piggyback is for IL.

We use alcohol caps on all ports and scrub the heck out of hubs and let them dry. Access is usually the primary site of infection.

Our infection rate is about 8%.

[NICU Guy, BSN, RN]

Don't your umbilicus sites get goooy with tegsdermon them? We have zero umbilical infections, for about 10 years now. We leave ours open to air, and just loop it to the side. Lines are changed every 96 hours.

For CVL and PICCs, sterile dressing changes every 7 days unless needed sooner.

Tubing changes for all lines except lipids and a few meds are every 96 hours, sterile. IL are every 24.

We had tubing especially made for our unit that has an integrated med line and three piggytails. We use the one with the filter as our main line, one is a med line that has a flush bag attached so the line is only broken when changing med syringes, and the other piggyback is for IL.

We use alcohol caps on all ports and scrub the heck out of hubs and let them dry. Access is usually the primary site of infection.

Our infection rate is about 8%.

Same except 72-96 hrs for continuous lines, 24 hrs for lipids and med lines. Sterile line changes and clean re-spike new bag or syringe change.

[BrandNewBabyNurse]

We also do 24h change out for IL and med infusions, the 72h is for continuous fluids. A new bag is clean spiked every 24h though, and then the full sterile line change is q72. Also forgot to mention that we use clear Microclave's on the ends of all forms of access, and use CHG scrubbers to clean hubs before connecting to them.

We haven't had issues with our tegaderms getting goopy, although I have heard that our unit educator is looking into the research behind open to air vs. covered.

[BrandNewBabyNurse]

Interesting, what's the rationale for Q24H changes on micro prems?

Several years ago our unit set out to really attack infection risks in our micro population, and it was found that doing a full sterile tubing change Q24 lowered our infection rates in the teeny tinies. There's also a practical component in that the volume/rate that most of their fluids/meds are running at is so minuscule, so each day when a new bag/concentration/etc... is hung, changing all the tubing out gets the fresh fluids/meds to the baby right away.

[vintage_RN, BSN, RN]

We use a "bridge" on our UVCs and the cath is just looped onto it and secured with tape and left open to air. 2 RN sterile line change for all central lines q72h except for lipids and med infusions. UVCs are usually taken out by 72h and I believe picc and broviak dressings are Q7 days and PRN