care of invasiveline in intensive care.

1. Care of the patients
with invasive line in
intensive care
Dr.Hardik patel.
INTENSIVIST
R.B.S. MAHAVIR HOSPITAL,SURAT.

2. Objective:

3. • Complication related to CVC LINE uses are
known to increase patients morbidity and
mortality and increases costs and length of
hospital stay.
• Education programs to promote best central
line practice have been shown to reduce CVC
complication.
• Purpose, to demostrate the effectiveness of
use of bundle,care and policy to reduces
the cvc related compli…..

4. Overview of CVC
The main types of CVCs are:
a) Nontunneled CVCs
b) Tunneled CVCs
c) Peripherally inserted central catheters (PICCS)
d) Implanted ports

5. a) Nontunneled CVC
Used for short-term therapy
Inserted percutaneously
Subclavian vein
Internal jugular vein
Femoral vein
Has from 1 to 5 lumens or ports
Usually from 15 to 30 cm in length

6. b) Tunneled CVC
Used for long-term therapy
• Inserted surgically or may be inserted by
Interventional Radiology
• Small Dacron cuff sits in subcutaneous
tunnel
• No dressing is required after cuff heals
unless the patient isimmunocompromised
• Line initially sutured with sutures removed in
7–10 days
• External portion of the catheter can be
repaired

7. c)Peripherally Inserted Central
Catheters (PICCs)
• Used for short-, intermediate-, and long-term
therapy
• May be single, dual, or triple lumen
• Inserted percutaneously
o Basilic vein
o Brachial vein
o Cephalic vein
• Advanced into the superior vena cava to the
juncture of the SVC and right atrium.

8. d) Implantable Ports
• Used for long-term therapies
• Surgically implanted
• Consists of metal, titanium, or plastic
housing with a dense
silicone septum in the center
• Catheter placed in superior vena cava
• Accessed with a special needle with a
deflected tip
• Dressing required until insertion site
healed

9. Challanges
• Two main challenges in intravenous (IV)
therapy are
the prevention of infection
and
the maintenance of patency.

10. CVC related complication
• Why we need Invasive lines?
• Contra indication
• Pathogenesis of CVC related infection
(CLABSI,CRBSI).
• Measure to reduce the infection.

11. Contraindication

12. Optimal position of CVC

13. CVC line related complication

14. Pathogenesis
• Crnich and Maki elegantly, Pathogenic organisms can
enter the extraluminal or intraluminal surface of an
indwelling vascular device.
• They suggested that the major sources are either device
colonization or infusion of contaminated fluid.

15. • Organism access to the device surface occurs by either:
1. Invasion of the percutaneous tract (during insertion or
in the subsequent days)
2. Contamination of the catheter hub during guidewire
insertion or during manipulation
3. Seeding from a remote source of localized infection.

17. Formation of BIOFILM

19. Concern with CVC LINE
• CRBSI: Clinical definition, defined by precise laboratory
findings that identify the CVC as the source of the BSI
and, used to determine diagnosis, treatment, and
possibly epidemiology of BSI in patients with a CVC.
• CLABSI: Used only for surveillance purposes to identify
BSIs that occur in the population at risk (patients with
central lines).

20. Diagnosis of CRBSI
• CRBSI criteria require one of the following:
A) Positive semi quantitative (>15 colony-forming units
[CFU]/catheter segment) or quantitative (>103CFU/catheter
segment) cultures whereby the same organism (species
and antibiogram) is isolated from the catheter segment
and peripheral blood
B) Simultaneous quantitative blood cultures with a ≥5:1
ratio CVC versus peripheral blood.
C) Differential period of CVC culture versus peripheral
blood culture positivity of >2 hours (DTTP).

21. Prevention of CRBSI
• The reduction was associated with the
implementation of multiple interventions
including targeted
• surveillance,
• prompt review of CRBSI cases,
• weekly team meetings, and
• regular reporting to clinical areas.

22. CRBSI BUNDLE
HAND HYGIENE
CHLOR HEXIDINE SKIN ANTISEPSIS
STERILE GOWN AND MAXIMUM BARRIER
PRECAUTION WITH LINE INSERTION
DAILY REVIEW OF LINE NECCESITY

23. CVC related care

25. Accessing CVC lines

30. CVC dressing overview

37. How to remove the dressing?

40. Clean site with chlorhexidine

42. Put a Bio patch.

45. • SUMMARY
• The hospital policy recommendation and
its implementation, regular data analysis
and review new implementation and active
participation of team member involving in
the patient care are require to prevent
CRBSI.

46. • The BSI rate in patients with central lines
is calculated using the following formula,
– BSIs in patients with central lines
central line days × 1000.
• The device utilization (DU) ratio is a
measure of patient days in which central
lines were used.
– central line days
patient days