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High Risk Central Lines

Learn about high-risk factors & interventions for central line-associated bloodstream infections. Presentation adapted from APIC 2014 Convention with practical tips & strategies.

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High Risk Central Lines

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  1. High Risk Central Lines Presentation adapted from APIC 2014 Convention “3024: High Risk Central Lines: What Else Can We Do?”

  2. CLABSI Risk Factors • Multiple catheters and/or multiple lumens • Emergency insertion • Prolonged duration of CVC • Prolonged hospital stay prior to CVC insertion • Excessive manipulation of the catheter • Neutropenia • Prematurity • Total parenteral nutrition • Source: CDPH “CLABSI Prevention” presentation

  3. Full body drape • Hand hygiene • Max barrier: sterile gown, gloves, mask and cap • CHG prep, SCRUB • CHG sponge at site • Monitor compliance to bundle • Needleless adaptor on all lumens • Anyone can call “STOP” • Daily assessment of continued need • Hand Hygiene • Scrub the hub – 15 sec (LET IT DRY!) • Clean, intact, occlusive dressing • Change tubing per policy • Evaluate lumen patency • Minimize access -> group activities • Flush per policy Insertion Bundle Maintenance Bundle

  4. At Multi-Care Health System, Washington (5 hospitals) • After implementation of CLABSI bundles (insertion and maintenance): Who was still getting infections? • Non- ICU patients • Long term lines • Oncology patients • Varied insertion sites • Short-gut kids

  5. Development of a High-Risk Algorithm – find them before they are infected!

  6. Decisions/Interventions

  7. High Risk Bundle – Adults • Daily baths with chlorohexidine wipes (start at central line site and work out, then chin to toes) • Daily linen changes • All central line tubing is to be secured in upward direction to prevent touching of things such as surgical wounds, ostomies, diarrhea (i.e. added infection risk sources)

  8. High Risk Bundle – Adults • Protect femoral line from diarrhea. Dress line in specific manner to help prevent IV tubing and line from coming in contact with diarrhea (i.e. larger dressings, skin protectants, etc…) • If central line dressing requires reinforcing, dressing needs to be changed • Discuss with MD the implementation of ethanol lock or antibiotic lock (depending on central line catheter material – ethanol not compatible with polyurethane, ok with silicone. Contact IVT for help/intervention).

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