1. CENTRAL LINES
AN OVERVIEW

2. 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

3. 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

4. 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!!!

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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)

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

14. CLABSI-CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS
APPROX 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

15. 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

16. 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

17. 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

18. 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
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