Certification of Central Venous Lines

1. Certification of Central Venous Lines Georgia Health Sciences Medical Center Augusta, Georgia November 13, 2012

2. The Joint CommissionNational Patient Safety Goal #72010 “Reduce the risk of healthcare associated infections”

3. NPSG.07.04.01 Implement best practice or evidence based guidelines to prevent central line associated bloodstream infections.

4. Elements of the Central Line Bundle: 1 • Hand hygiene • Maximal barrier precautions upon insertion • Chlorhexidine skin antisepsis • Optimal catheter site selection, with avoidance of using the femoral vein for central venous access in adult patients • Daily review of line necessity, with prompt removal of unnecessary lines

5. What is a “Certified Line”? • Inserted by a “Qualified Inserter” • Witnessed by a “Qualified Observer” • Having at least 2 people present at all times during the insertion procedure. • Verified by the “Qualified Observer” through documentation in the medical record that: • All components of the CVL Bundle were followed, and • No breaks in sterile/aseptic technique occurred • Documented as “certified” in the medical record by the “Qualified Observer” • All components of the bundle must be followed with no breaks in sterile/aseptic technique. • NOTE: If components of the “bundle” are not adhered to, documentation by the “Qualified Inserter” indicates appropriate reason deviation occurred and can still be certified.

6. 2 “Certified Line” = “Qualified Inserter” + “Qualified Observer” (A non-certified line should be removed within 24 hours of insertion.)

7. Who is a “Qualified Inserter”? A Physician, PA or Advanced Practice RN who has met these two criteria: Successfully checked off by their service as competent in the insertion of central lines and credentialed for CVL insertion Successfully demonstrated competent use of the CVL Bundle by attending the CVL Bundle Program sponsored by Hospital Epidemiology

8. Who is a “Qualified Observer”: • Vascular Access Teams (AVAT/PVAT) • Pediatric and Adult ICUs • General Nursing Units • Registered Nurses in: • Interventional Radiology • Emergency Department • Operating Rooms (circulating nurses) • Critical Care Units • Pediatric Units

9. 5 Adult Vascular Access Team - AVAT • 13 members • 24/7 Coverage • Preferred first contact for central line insertion observation • Routine maintenance for all central lines • Insertion of PICC lines

10. Pediatric Vascular Access Team-PVAT • 8 PVAT members • CMC Coverage • Preferred first contact for central line insertion observation • Routine maintenance for all central lines • Insertion of PICC lines

11. Computerized Physician Order Entry(CPOE) Activates the VATs

12. CPOE Continued

13. CVL Bundle Program Consists of: • 1 hour didactic class • National Patient Safety Goals • Central Line Bundle • Hospital Policy • Policy access on the intranet • Basic Asepsis within surgical field • Competency demonstration in a simulated lab • Skills assessed: • Surgical scrub / Donning sterile attire • Skin prep / draping / Central Line Bundle • Dressing & antimicrobial disc application • Documentation of insertion and bundle • Access to policies/procedures on line

14. CVL Bundle Program Upon successful completion of the program a badge is given to identify them as a “Qualified Inserter”

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16. Next Step Incorporate “Qualified Inserter” verification into the Procedure Time Out process and documentation using the “red” Asepsis (CVL Bundle) Program badge.