What is your units procedure on accessing central lines?

[hcox1975, BSN, RN]

I'm curious to how other nicus access their central lines. Do you use sterile technique with hat, mask and sterile gloves? Do you clean the port with betadine and then access? What is your infection rate?

[NicuGal, MSN, RN]

We have a central line bundle in place, we adapted from ihi.org We don't do sterile procedure to access lines. We cleanse the hub with alcohol (chlorhex if cultures), let air dry and then access. We also went to a closed med line. We have had zero umbilical line infections in over 5 years, we do still have PICC line infections..seems to be a problem since IR puts them in the groin on kids we can't get other access on, but we are still below benchmark. We had a huge re-education and rollout with everyone that comes in contact with lines having to attend, give a return demo and be signed off. Nurses, docs and RT alike, since we treat our arterial lines the same way.

• Perform hand hygiene.
  
• Put on clean gloves prior to accessing the line.
  
• Perform a 30-second “hub scrub” using alcohol and friction in a twisting motion on the hub as if you were juicing an orange. Let air dry for at least 15 seconds.
  
• Infuse medication or draw the blood and label as per the policy.
  When removing the syringe/adapter from the hub cleanse again with alcohol.
  
• Discard gloves and perform hand hygiene.
  
  
  
  

[umcRN, BSN, RN]

We only access broviacs on my unit as our PICCS are too small for blood draws. They are typically only accessed at line change OR if the kiddo starts acting sick and we need a lot of labs, otherwise we do not access our central lines for anything, heel sticks and a-lines (if available) only for blood draws. We use a closed med line as well. We do not need to be sterile to access the line, we just scrub with chlorahex.

In the peds cardiac ICU I work in now we can access any central line that is 3Fr or larger, typically we try to set up a designated port for lab draws and we use a two stop-cock system with two syringes and a flush so that it is technically a "closed" system.

I can't recall the last time I heard of a line infection in either the nicu or pcicu to be honest though I don't know the actual stats

[NicuGal, MSN, RN]

We use a biosensor if we have need to access for blood draws on any of our lines. Nice closed system. Our bigger babies get 3fr fem lines so we can draw off those...makes life nice! We just have a problem with fem lines...but when we need a line, that is where it goes. We rarely have Broviacs.

[nicuyoyo]

This is a great topic! For those of you that use chlorohex to scrub the hub do you have a manufacturer? Are you using swabsticks, pads or something else?

[Double-Helix, BSN, RN]

We use a central line bundle and NACHRI guidelines:

When accessing through a closed port (we use clear-link caps)

1. Hand hygiene and clean gloves before touching the line.

2. Clorahexadine swabstick 30 second scrub, 30 second dry time.

3. Access the line. If you're pushing a medication, there is no need to re-scrub between flushes. But if you walk away from the bedside or clean technique is compromised, then rescrub.

When opening the system (changing lines, changing caps, etc)

1. Hand hygiene

2. Set up a sterile field under the line.

3. Don mask and sterile gloves.

4. Chlorahexadine 30 sec scrub, 30 sec dry before removing the old caps/lines

5. Use sterile technique to change the lines/caps.

When changing a central line dressing:

1. Hand hygiene, don mask and clean gloves. Anyone at the bedside wears a mask.

2. Clean technique to remove old dressing.

3. Hand hygiene again, don sterile gloves

4. Clean the site with Chlorhexadine for 30 seconds if the child is over two months. Use beta dine if under two months old.

Allow the site to dry completely. *If the site is a femoral access, scrub for two minutes*

5. Replace the dressing using sterile technique.

Following these guidelines, our PICU has been central line infection free for over two years.

[Brittanya34]

We use chlorahexadine for access to any central line for anything.

[obprof]

For accessing central lines, we use hand hygiene, don sterile gloves and clean the hub for 15 sec with a cleaner that is used like a "juicer". For changing lines, we don hat, mask, gown, gloves and use sterile technique.