CENTRAL LINES AN OVERVIEW

RISKS ASSOCIATED WITH CENTRAL LINES THERE IS A HIGHER RISK OF INFECTION, WHY? PATIENT IS COMPROMISED AND VULNERABLE SKIN IS PUNCTURED WITH DEVICE SKIN MICROBES MAY ENTER THROUGH THE DEVICE PATIENT IS EXPOSED TO HCW DURING ACTUAL PLACEMENT PROCEDURE AND/OR DRESSING CHANGE

FACTORS PREDISPOSING TO INFECTIONS HOST-PATIENT AGE DISEASE-CHRONIC OR ACUTE DIAGNOSTIC PROCEDURE TRAUMA PRE-EXISTING INFECTION NEAR THE INSERTION SITE THERAPEUTIC REGIME-ANTIBIOTIC THERAPY, IMMUNOSUPPRESSIVE THERAPY, ANTINEOPLASTIC AGENT SURGERY AND OTHER INVASIVE PROCCEDURES PROLONGED USE UNNECESSARY USE ORGAN TRNSPLANT LENGTH OF HOSPITAL STAY

RISKS CONTINUED WHAT ARE THE CLINICIAN’S RESPONSIBILITIES? KNOW THE INSTITUTIONS POLICIES AN DPROCEDURES UNDERSTAND WHAT TYPE OF VASCULAR ACCESS IS BEING USED AND ITS MANAGEMENT PRACTICE PREVENTIVE MEASURES TO IMPROVE PATIENT OUTCOMES AND PATIENT SATISFACTION NURSES ARE ON A MISSION TO PREVENT CLABSI!!—THIS MEANS USING ASEPTIC TECHNIQUE, DETECTING COMPLICAITONS EARLY AND EARLY INTERVENTION!!!

WHY DO WE CARE ABOUT THIS? INFECTIONS HAVE ADVERSE REACTIONS AND OUTCOMES INCLUDING DEATH INFECTIONS LEAD TO INCREASE USE OF ANTIBIOTICS INCREASED USE OF ANTIBIOTICS LEADS TO THE DEVELOPMENT OF DRUG RESISTANT ORGANISMS INFECTIONS PROLONG HOSPITAL STAY HOSPITALS WILL NOT BE REIMBURSED BY MEDICARE FOR THESE HOSPITAL ACQUIRED INFECTIONS

NURSES NEED TO SAVE THAT LINE! SCRUPULOUS HAND HYGIENE-BEFORE AND AFTER ANY CONTACT WITH A VASCULAR LINE ACCESS AND PRIOR TO INSERTION ASEPTIC TECHNIQUE-DURING INSERTION AND SITE CARE VIGOROUS FRICTION TO THE HUBS-VIGOROUS FRICTION WITH ALCOHOL WHENEVER YOU MAKE OR BREAK A CONNECTION TO GIVE MEDICATIONS, FLUSH OR CHANGE TUBING AND INJECTION PORT OR ADD ON A DEVICE ENSURE PATENCY-FLUSH WITH ADEQUATE AMOUNT OF SALINE OR HEPARINIZED SALINE TO MAINTIAN PATENCY PER INSTITUTION POLICY

REMEMBER SURFACE MICROBES DO NOT PUT TAPE ON THE BEDSIDE TABLE, BEDRAILS, IV POLE OR ON YOUR PERSON- TEAR TAPE AS YOU NEED TO AND IF YOU HAVE TO PLACE TORN TAPE ON STERILE PACKAGE OR CLEANED SURFACE SANITIZE YORSELF AND WORK SURFACE DON PERSONAL PROTECTIVE EQUIPMENT AS NEEDED

DISINFECTANTS USE CHLORAPREP-WHICH IS 2% CHLORHEXIDINE AND 70% ALCOHOL CHLORAPREP EFFICACY IS 48 HOURS OR GREATER MUST DO A 30 SECOND SCRUB- BACK AND FORTH MOTION, NOT CIRCULAR-REASON IS YOU CANNOT SEE WHERE IT IS GOING BECAUSE IT IS CLEAR, UNLIKE BETADINE BE SURE YOU PREP THE AREA WHICH IS EQUAL TO OR GREATER THAN THE DRESSING SIZE BE SURE TO SCRUB THE HUB WITH ALCOHOL FOR 30 SECONDS-USE FRICTION WITH NEEDLELESS SYSTEMS, THE SCRUBBING MAKES THE DIFFERENCE

CHOOSE THE RIGHT ACCCESS DEVICE CONSIDER THE PATIENT’S VEINS-MUST CONSIDER PRESERVATION OF VEINS CONSIDER THE BEST ACCESS TO COMPLETE THE THERAPY CONSIDER THE TYPE OF INFUSATE CONSIDER THE LENGTH OF THERAPY CONSIDER THE PATIENT’S CONDITION

PHLEBITIS-INFLAMMATION OF THE VEIN 0-NO SYMPTOMS 1-ERYTHEMA AT THE ACCESS SITE WITH OR WITHOUT PAIN 2-PAIN AT THE ACCESS SITH WITH ERYTHEMA AND/OR EDEMA 3-PAIN AT THE ACCESS SITE WITH ERYTHEMA AND/OR EDEMA, STREAK FORMATION, PALPABLE VENOUS CORD 4-PAIN AT THE ACCESS SITE WITH ERYTHEMA AND/OR EDEMA, STREAK FORMATION, PALPABLE VENOUS CORD>1 INCH IN LENGTH WITH PURULENT DRAINAGE

INFILTRATION-INADVERTENT ADMINISTRATION OF NON-VESICANT MEDICATION OR SOLUTION INTO THE SURROUNDING TISSUES 0-NO SYMPTOMS 1-SKIN BLANCHED, EDEMA,1 INCH IN ANY DIRECTION, COOL TO TOUCH, WITH OR WITHOUT PAIN 2-SKIN BLANCHED, EDEMA, 1-6 INCHES IN ANY DIRECTION, COOL TO TOUCH, WITH OR WITHOUT PAIN 3-SKIN BLANCHED, TRANSLUCENT, GROSS EDEMA.6INCHES IN ANY DIRECTION, COOL TO TOUCH, MILD TO MODERATE PAIN, POSSIBLE NUMBNESS 4-SKIN BLANCHED, TRANSLUCENT, SKIN TIGHT, LEAKING, SKIN BRUISING, SWOLLEN, GROSS EDEMA.6 INCHES IN ANY DIRECTION, DEEP PITTING EDEMA, CIRCUATORY IMPAIRMENT, MODERATE TO SEVERE PAIN, INFILTRATION OF ANY AMOUNT OF BLOOD PRODUCTS, IRRITANT OR VESICANT

EXTRAVASATION EXTRAVASATION-IS THE INADVERTENT ADMINISTRATION OF VESICANT MEDICATION OR SOLUTION IN THE SURROUNDING TISSUE OCCURS WHEN SOLUTIONS ARE VERY ACIDOTIC OR ALKALOTIC INFUSIONS WITH PH <5 OR >9 SHOULD BE INFUSED CENTRALLY EXAMPLES ARE VANCOMYCIN 2.4, DILANTIN 10-12, BICARB, LEVOPHED, DOPAMINE, CALCIUM CHLORIDE, D50 (TPN) OR D10 (PPN), (KCL 80MEQ/1000CC IS MAXIMUM FOR PERIPHERAL)

OSMOLALITY OSMOLALITY OF THE BLOOD IS 280-295 mOsm/L ADMIXTURES OF >600mOsm/L REQUIRE CENTRAL LINES EXAMPLES INCLUDE TPN AND 50%DEXTROSE

CLABSI-CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS APPROX 6.5-7 MILLION CENTRAL LINE ACCESS DEVICES PLACED PER YER APPROX 350,000 CLABSI PER YEAR 3RD MOST PREVALANT HEALTHCARE ASSOCIATED INFECTION COST TO TREAT IS $25,000-$56,000 PER CASE APPROX COST IS $2.3 BILLION PER YEAR ABOUT 12-25% RESULT IN INFECITON RELATED DEATHS

CENTRAL LINE DRESSING CHANGE DRESSING CHANGE EVERY 7 DAYS OR PER HOSPITAL POLICY PRN DRESSING CHANGE WHENEVER THE INTEGRITY IS COMPROMISED DUE TO WET, LOOSE OR SIOLED TRANSPARENT DRESSING IS CHANGED EVERY 7 DAYS GAUZE DRESSING IS CHANGED EVERY 2 DAYS LABEL WITH DATE, EXTERNAL IN CM, RN INITIAL MEASURE SKIN CATHETER EXIT SITE TO THE ZERO MARK IN CM WHEN LABELING

AIR EMBOLISM SYMPTOMS-CHEST PAIN, SHORTNESS OF BREATH, SHOULDER OR LOW BACK PAIN, CYANOSIS, HYPOTENSION, WEAK THREADY PULSE, CONTINOUS CHURNING SOUND OVER THE PRECORDIUM ON AUSCULTATION, FEELING FAINT OR LOSS OF CONSCIOUSNESS, SHOCK WITH CARDIAC ARREST IF CONDITION NOT TREATED OR RECOGNIZED EMERGENCY TREATMENT NEEDED-PLACE IN TRENDLENBURG POSITION ON LEFT SIDE, ADMINISTER O2, TAKE VS, ACTICVATE CODE BLUE, CALL MD

BLEEDING TO PREVENT ACTIVITY RELATED TO BLEEDING, PT RESTING IN ED, MINIMUM 30 MIUTES IF BLEEDING HOLD PRESSURE UNTIL CONTROLLED-APPLY PRESSURE, MONITOR SITE EVERY 15 MINUTES, KEEP PRESSURE DRESSING FOR 24 HOURS, CALL MD SHOULD-REMAIN

OH NO!!! PATIENT PULLED OUT THE CENTRAL LINE FULLY RECLINE PATIENT ASAP IMMEDIATE PRESSURE TO SITE EXAMINE SITE FOR BLEDDING CLEANSE SITE WITH CHLORAPREP APPLY VASELINE GAUZE OR ANOTHER OCCLUSIVE STERILE DRESSING CHECK IF CATHETER TIP IS INTACT AND LENGTH WATCH FOR SIGNS OF AIR EMBOLISM OR BLEEDING NOTIFY MD DOCUMENT