This document defines central lines and central line-associated bloodstream infections (CLABSI). It discusses common sites for central venous catheter placement, equipment used, and nursing responsibilities for post-insertion care. Key points on preventing CLABSI include educating healthcare workers, using sterile barriers during insertion, disinfecting catheter hubs before access, and changing dressings regularly. Removing central lines also requires following systematic steps to avoid complications.

1. Central lines and
Prevention of Central Line-Associated
Bloodstream Infections (CLABSI)

2. Objectives
•Define CL, CVC and CVP.
•Identify common routes of CVC placement.
•Identify the equipment used and nursing
responsibilities of post CVC insertion.
•Define CLABSI and steps for prevention.

3. Definitions
•Central line (CL)- An intravascular catheter that terminates
at or close to the heart or in one of the great vessels.
•CLABSI – Central Line Associated Blood Stream Infection.
A Confirmed Laboratory Blood Stream Infection.
•CVP – Central venous pressure is the blood pressure in the
vena cava, near the right atrium. It reflects the amount of
blood returning to the heart.

4. Common placement of CVC/CL

5. Types of CVC
Types of CVC/CL catheters

6. Indications for Central Venous Cannulation
• Measurement of central venous pressure
• Large-bore venous access
• Administration of irritating drugs, examples:
• Vasoactive drugs
• Chemotherapy drugs
• Parenteral nutrition

7. Other Indications
• Difficult or long-term IV access
• Hemodialysis
• Placement of a temporary pacing wire
• Placement of a pulmonary artery catheter
• Measurement of ScvO2

8. Monitoring CVP
•A central venous catheter (CVC) or central line (CL) in
the internal jugular or subclavian vein allows
measurement of central venous pressure (CVP).
•CVP estimates the right ventricular filling pressure. It
reflects the preload or end-diastolic volume.
•Normal values for CVP are 2 to 8 mm Hg and
measurements should be made at the end of expiration.

9. Assessment of patient
prior to CVC insertion
• Information
-Procedures, advantages & disadvantages, risk involved
explained to patient and informed consent consent
obtained.
• Assessment
-Risk of bleeding, pneumothorax, arrhythmia
-Implanted defibrillators, pacemakers
-History of previous catheterizations

10. Equipment required
CVC catheter set
CVC Set
Lidocaine, gauze, tegaderm, IV fluid, CVP, sterile, full
body drape, gloves, gown.

11. Preparation of patient
for procedure
• Gather equipment.
• Explain the procedure to the
patient.
• Place the patient in supine
position with head of the bed flat
or slight Trendelenberg (head
down).
• Assist the physician while
inserting the CV catheter.
• The catheter is inserted under
aseptic technique with full body
drape.

12. Confirmation of CVC placement
Chest X-ray
• To ensure CVC is in the
internal jugular or subclavian
vein.
• To detect complications from
the procedure such as
pneumothorax.

13. Nursing management post-
CVC catheter insertion
Dressing at CVC site
•Change dressing under aseptic technique and use sterile
gloves.
•Assess the patient for signs of respiratory distress, which may
indicate a pneumothorax or air embolism.
•Clean and apply ointment, and then cover the site with a
sterile gauze dressing.
•Change the dressing every 24-48 hours.
.

14. Prevention of CLABSI
• Before insertion
• Educate healthcare personnel involved in the insertion
• At insertion
• Use catheter checklist
• Avoid using the femoral vein
• Use maximal sterile barrier precautions
• After insertion
• Disinfect catheter hubs and injection ports before accessing
• Change gauze dressings every 2 days

15. Hand hygiene
Hand hygiene should be the cornerstone of CLABSI
prevention efforts:
•For both insertion and maintenance
As part of a hand hygiene intervention consider:
•Ensuring easy access to soap and water and alcohol-based
hand gels
•Education for healthcare providers and patients

16. Skin preparation
Chlorhexidine is the preferred agent for skin cleansing for
both CL insertion and maintenance:
•Tincture of iodine, an iodophor, or 70% alcohol are
alternatives
•Recommended application methods and contact time
should be followed for maximal effect
Prior to use should ensure agent is compatible with
catheter:
•Alcohol may interact with some polyurethane catheters
•Some iodine-based compounds may interact with silicone
catheters

17. CL site choice
•For adult patients receiving non-tunneled CL, femoral
site should be avoided due to an increased risk of
infection and deep venous thrombosis.
•Note:
•In patients with renal failure, subclavian site should
be avoided to minimize stenosis which may limit
future vascular access options.

18. Hub/access port cleansing
•BSI “outbreaks” have been associated with failure to
adequately decontaminate catheter hubs or failure to
change them at appropriate intervals
•Cleanse hubs prior to use with an appropriate
antiseptic (e.g., 70% alcohol)
•Manufacturer recommendations regarding cleansing
and changing connectors should be followed

19. Prevention of CLABSI
•Before insertion
• Educate healthcare personnel involved in the insertion
•At insertion
• Use a catheter checklist
• Avoid using the femoral vein
• Use maximal sterile barrier precautions
•After insertion
• Disinfect catheter hubs and injection ports before accessing
• Change gauze dressings every 2 days

20. Removing a CVC
General rules
• Assist the physician in removing a CVC or a Nurse is
permitted to remove the catheter with a physician’s order.
• If the head of the bed is elevated this minimizes the risk of
air embolism during catheter removal. If patient can’t
tolerate this, position them flat.
• Turn the patient’s head to the side opposite the catheter
insertion site.

21. Removing a CVC
•Make sure IV solution off and line is clamped.
•Remove the dressing and expose the insertion site.
•If sutures are in place then remove them carefully.
•Pull the catheter out in a slow, smooth motion and then
applie pressure to the insertion site.
•Re-dress the post CVC insertion site

22. Key Points
•A central venous catheter or central line can be used
to administer medications or measure CVP.
•Removing a central line needs to be done in
systematic manner to prevent complictions.
•Steps should be taken to prevent central line
associated blood stream infections or CLABSI.

23. Key Points
•Remove unnecessary CL when possible
•Follow proper insertion practices
•Comply with hand hygiene recommendations
•Perform adequate skin antisepsis
•Choose proper CL insertion sites
•Perform adequate hub/access port disinfection
•Removing a central line needs to be done in systematic
manner to prevent complictions.

24. Questions
•What does CLABSI stand for?
•Explain how catheters can get contaminated.
•What are recommended sites for central line
insertion?
•What are recommended measures to prevent
CLABSI?