Inconsistent Central Line Practice Concern

[Nurse Beth, MSN]

Dear Nurse Beth,

Our information in central line maintenance is outdated and staff are performing it in inconsistent ways. Can you help? Looking for the most recent information/suggestions/policies.

Dear Best Practice,

That's a great question, and we all want to follow evidence-based practice. Evidence-based practice around central venous access catheters (CVADs) is based on preventing infections, specifically central line-associated bloodstream infections (CLABSI). CLABSIs are considered hospital-acquired infections (HAI) by CMS, and stringent practice must be observed when checking the line or changing the dressing.

If you have access to Lipincott Procedures, follow Lippincott for insertion, flushing, locking, maintaining, sampling, etc. If not, the Infusion Nurses Society (INS) is the authoritative nursing organization on IV therapy. I'm a member, and it is worth it to have access to the infusion Therapy Standards of Practice. The CDC has guidelines as well.

There are so many aspects to managing central venous access catheters, so I will highlight a couple, and hope they are helpful to you and your team.

CVADS should be inserted using maximal sterile barrier precautions. This includes PICC lines. Maximal barrier precautions are:

• Sterile gloves
• Sterile gown
• Sterile drape
• Cap and mask

CVADs should be assessed for continued need every shift and removed as soon as they are no longer needed.

One time use disinfection caps on each port have been shown to reduce infections. (Discard after removal). If no caps are used, a vigorous 5 to 15 second scrub with a disinfection agent (ex., isopropyl alcohol) is recommended.

Unless there is residual blood or contamination, change needless connectors no more frequently than every 96 hours. Changing more frequently increases the risk of central line-associated bloodstream infections (CLABSI).

Transparent semipermeable membrane dressings should be changed every 5 to 7 days and gauze dressings every 2 days. Chlorohexidine -impregnated dressings at the insertion site and transparent semipermeable dressings are recommended.

There is a lot to learn about best practices, but there is a lot of information available as well. I hope you will become a CVAD champion!

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[NRSKarenRN, BSN, RN]

Good article + interview about nurses from Swedish Medical Center, Seattle, Washington how they utilized a Clinical Scene Investigator (CSI) approach to reduce CLABSI rates in their ICU.

Utilizing CSI to Reduce Central Line Infections - Meet the CLABSI Rangers