ICU Question about central line infection control

[Benj2610]

Doing a PICO project and it would be helpful to know from any ICU RN's or anyone that may have an answer...

Do ICU RN's do dressing changes on IJ's / central lines?

and

Are Chlorhexidine baths standard practice in the ICU (for IJ's/Central lines)

- Thanks

[dream'n, BSN, RN]

I don't know about the ICU, but on my old floor we the RNs changed the central line dressings ourselves. And no we did not use Chlorhexidine baths with patients that had IJs/Central lines.

[sevensonnets]

Of course we do.

[Okami_CCRN, BSN, RN]

Our ICU policy is to change central line dressings q7 days or when dressing is visibly soiled, moist, or no longer intact. (dressing changes done by RN)

We provide daily baths with pre-packaged CHG wipes and so far have had great success with a CLABSI rate of 0% for the past couple of months.

We also are very diligent about IV tubing changes, scrubbing the hub, and other EBP protocols.

[Benj2610]

I figured that the IJ might be removed and the patient on the way to the floor before you have the opportunity to do the dressing change. So assuming a patient is in the ICU for say 9 days for instance, you would change the IJ dressing and do the CHG bath per protocol just like a floor RN would do for a PICC?

[Benj2610]

Very helpful... thank you all! I type too slow, missed that last response. Disregard my last question.

[AceOfHearts<3]

At my old facility where I wasn't ICU anyone with a central line got a chlorhexidene wash daily. The rational is that that chlorhexidene penetrates the first 3 layers of skin and if done once every 24 hours it greatly reduces the bacterial load (the bacteria can't multiply as fast). This is EBP and has shown reduce CLABSIs.

On units other than ICU the dressing was changed every 7 days (unless visibly soiled before then) by a member of the IV team. I know floor nurses at other facilities that did their own dressing change. I'm not sure if the ICU nurse did the change at my old facility or if the IV team nurse did it there as well.

[Here.I.Stand, BSN, RN]

Anywhere I've worked, bedside RNs have done the dressing changes.

In my ICU, everyone gets a daily CHG rub-down after their soap&water bed bath. (Unless it's contraindicated, of course.) If surgery is planned, the pt gets one the evening before and the morning of.

[tcvnurse, BSN, RN]

At my ICU, RNs change the central line dressing weekly or pen if soiled and every patient in our ICU gets a CHG bath QD

[AnnieOaklyRN, BSN, RN, EMT-P]

It depends on the hospital. Where I work I am part of the IV team and we do the central line dressings, even in ICU.

Annie

[mrsboots87]

Why would you think an IJ or SC would need to be pulled before moving to the floor from the ICU? All nurses use central lines. Not just ICU nurses. I work on a tele unit and one of the surgeons puts them in at bedside all the time for peeps that need long term meds and/or frequent blood draws. Heck, I just assisted on one today.

We do weekly dressing changes, and on my unit, the floor nurses all do their own dressing changes. As far as chlohexadine baths, we don't do those.

[mrsboots87]

Also, FYI, IJ's are central lines. There a multitude of CVC's including IJ, SC, TACC lines, ports, HD caths, trialysis caths, swans, all kinds. You can just call them central lines or CVC's.