Central Line Placement and Masks

Generally the people placing the lines wear the masks or the people that are almost breathing on the patient's neck have to wear the mask. Otherwise, no.

In our Peds ICU everyone including the patient (if not intubated) was masked. Provider was also gowned.

The rule is that everyone who gets within 3 feet has to mask, this is taken pretty seriously at every place I've worked including the ER and everyone does actually wear a mask for going into the room beyond the doorway.

Yes, masks worn.

It's a good idea to, even if you're not within three feet and in the same room.

Once when I was (essentially) circulating for a central line placement in the ICU, the resident became woozy and I crawled under the drape, caught her as she fainted and dragged her over to the window. I mean, that's probably not going to happen to you, but I wouldn't have had time to mask up at that moment. (We did not break the sterile field, the senior resident finished the job. And she was fine and went on to pass out a few more times in similar situations).

Everyone in the room must have a mask and scrub cap/bouffant, the patient is has maximal barrier precautions in place including a full body drape (their face will be under the drape), and anyone placing or assisting must have a sterile gown and gloves on.

We use the exact same precautions as our NICU, PICU, and adult ICUs.

Maximal Barrier Precautions Defined

Best practice is use of maximal barrier precautions which means strict compliance with hand hygiene and wearing a cap, mask, sterile gown, and sterile gloves and covering with a large head to toe sterile drape. The cap should cover all hair and the mask should cover the nose and mouth tightly. There should be an empowered observer that monitors the entire procedure to make certain there is no breach in practice and no one enters without a mask and cap on and and maybe even a gown depending on how close they get. The empowered observed also monitors for a break in sterile procedure/technique such as when a sterile glove inadvertently touches a non-sterile item when being applied. The empowered observer has the responsibility to stop the procedure until the breach is corrected and should be filling out the CLIP form (If in US). Are you not doing this?

yup, hat and mask. Sterile gown and gloves if you are participating in insertion.

When I worked in an ER though, this didn't happen on occasion in an emergency and the line was considered dirty and was only used for about 24 hours before being pulled.

Annie

Yes, generally. I'm kind of lenient on this issue. If I am placing a PICC say, in a very large E.D. room and the family is sitting in a chair 10 feet away, no. In one of our small inpatient rooms everyone wears a mask.

In your hospital or facility, is everyone in the room supposed to wear masks for CVC placement?

In the ERs I worked in, yes this was a policy. When there were emergencies in which every second counted however, not everyone who needed to be at the bedside could be properly masked up in time. This was acceptable as long as it was documented in the chart along with the reason for the protocol deviation.

The person placing the line was expected to be gowned, but no one else. Strangely the ICUs in these facilities mandated caps too, but not the ERs. Eyewear was also required in OR settings, but not anywhere else that I've worked.