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    Cvl bundle presentation Cvl bundle presentation Presentation Transcript

    • Central Venous Lines and Blood Stream Infections Breaking out the Bundles Elizabeth Gilger, RN, CCRN Medical University of South Carolina
    • Infection Control Did you know? Approximately 90% of catheter related blood stream infections (BSI) occur with central venous catheters (CVC) Between 500 and 4,000 patients die annually from BSI Institute for Healthcare Improvement, 2007
    • Infection Control Did you know? Mortality of ventilated patients who develop VAP is 46 % $40,000 is the estimated cost accumulated due to VAP Institute for Healthcare Improvement, 2007
    • Blood Stream Infections Disruption of the integrity of the skin creates an avenue for infection Infection spreads to the bloodstream leading to Hemodynamic changes and organ dysfunction and potentially may lead to death
    • Institute for Healthcare Improvement (IHI) Developed in 1991 to improve health care worldwide Developed improvement measures based on research. Many of these measures had been previously recommended by CDC in their guidelines for the prevention of CVL related bloodstream infections. Incorporated bundles into the healthcare culture to ensure standardized practice
    • What is a bundle??? Bundles are groupings of best practices with respect to a disease process that individually improve care, but when applied together result in substantially greater improvement. Institute for Healthcare Improvement, 2007
    • Central Line Bundle Hand Hygiene Maximal Barrier Precautions Upon Insertion Chlorhexidine Skin Antisepsis Optimal Catheter Site Selection, with Subclavian Vein as the Preferred Site for Non-Tunneled Catheters Daily Review of Line Necessity with Prompt Removal of Unnecessary Lines
    • Think Outside the Bundle CVL Assessment – Each shift, assess for patency, site condition and dressing patency – If the CVL was placed in a true clinical emergency, the line is to be changed after 24 hours
    • Think Outside the Bundle CVL Care – Change transparent dressings every 7 days, those you cannot visualize the site i.e. gauze dressing, change every 24 hours – Change tubing and caps every 72 hours – Cleanse caps prior to tubing change, IVP medication or flushing with alcohol swab. Use friction!
    • Insertion Site selection-recommended site in adults is the subclavian site. For pediatrics-no data. Full barrier precautions should be used-MDs should use gown, hat, gloves and mask. If you are in and out of the room, wear a mask. If you stand there the entire time, you should use full barriers, too. Antibiotic impregnated catheters recommended for lines that are anticipated to remain 7 days or more.
    • Policy 75-A Prior to placement of the line, someone, usually the RN, is designated to monitor the sterile field and practice. This designee must stop the procedure if the appropriate steps are not followed. If the patient is conscious, the designee will stop the procedure by saying “Break Scrub”: indicating to the clinician that the bundle has not been followed and the procedure must be stopped. If the clinician does not stop the procedure, the RN is to notify the nurse manager. Find this checklist on the Clinician’s Order site at http://www.musc.edu/cce/ORDFRMS/
    • CVL Insertion Carts and Supplies To facilitate adherence to the bundle, carts are being purchased for nursing units These carts will hold necessary supplies Physicians have participated in the selection of drapes for the adult and pediatric populations. A variety of drapes are available in different styles and sizes.
    • CVL Cart 1. After use, clean cart thoroughly with Cavicide. 2. For isolated patients, avoid taking cart inside the room. 3. Restock after each use from the Pyxis, charging supplies to the patient. 4. Check daily to make sure lock is secure. 3 rolls of tape 6 OpSites 6 Chlorapreps 2 boats 4 x 4s 4 Biopatch 6 10 ml syringes 4 packs KY 4 vial adaptors 2 transducer covers 4 vials 30 ml saline 6 injection ports 3 sterile gowns Sterile Gloves: 2 of Box of hats Box of masks each 6.5, 7, 7.5 and 8 2 Proxima Drapes 2 Arrow Drapes 2 triple lumens 1 Long Quinton 2 Cordis 2 quad lumens 1 Short Quinton
    • And wash your hands!!!!!!!! You can’t be too clean!!! http://www.learnovation.com/johnwise_samples.htm
    • Question 1 1. Which of the following personal protective equipment are required to be worn by the physician for central venous line insertion? a) Gloves and gown b) Gloves, gown and mask c) Gloves, gown, mask, and hat d) None of the above
    • Question 2 2. The preferred site for central venous line placement in adults is a) Jugular vein b) Femoral vein c) Subclavian vein d) All of the above are acceptable
    • Question 3 3. The Central Line Bundle includes all of the following except: a) Hand hygiene b) Daily review of line necessity c) Ensuring optimal site selection d) Chlorhexidine skin antipsesis e) Keeping the HOB elevated 30 degrees
    • Question 4 4. The RN or designee in the CVL placement procedure has the authority to stop the procedure if sterile technique is broken by saying: a) “Time Out” b) “Break Scrub” c) “STOP!” d) The RN or designee cannot stop the procedure
    • CONSISTENCY IS BEST PRACTICE