1. Jan Bazner-Chandler RN, MSN, CNS, CPNP
IV Management
Jan Bazner-Chandler
RN, MSN, CNS, CPNP

2. Central Venous Catheter

3. Central Line Bundle Hand Hygiene
Maximal barrier precautions upon insertion
Chlorhexidine skin antisepsis
Optimal catheter site selection; subclavian vein is the preferred site for non-tunneled catheter
Daily review of line necessity with prompt removal of unnecessary lines

4. CA-BSI Central venous catheter-associated blood stream infection
Three criteria for diagnosis

5. Criterion I
A recognized pathogen in the blood found from one or more blood cultures, and the pathogen is not related to an infection at another site.

6. Criterion 2
Patient has at least one of the following signs or symptoms: fever (over F or 38 C, chills, hypotension and
Positive laboratory results not related to infection at another site
Common skin contaminant identified in two separate cultures taken within 48 hours of each other.

7. Criterion 3
A patient less than one year old has at least one of the following signs or symptoms: fever (over F or 38 C) or hypothermia (under 98.6 F 37 C) apnea, or bradycardia and
Positive laboratory results not related to an infection at another site
Common skin contaminant found in two blood draws – within 48 hours

8. Risk Factors Three lumen catheters TPN running through central line
Inexperienced physician inserting line
Low patient – nurse ratio
Long – term catheter
Special care units

9. Total Parental Nutrition
A tunneled catheter should have
An occlusive dressing in place.
Whaley & Wong

10. TPN Therapy
TPN provides complete nutrition for children who cannot consume sufficient nutrients through gastrointestinal tact to meet and sustain metabolic requirements.
TPN solutions provide protein, carbohydrates, electrolytes, vitamins, minerals, trace elements and fats.

11. TPN: care reminder caREminder:
The TPN infusion rate should remain fairly constant to avoid glucose overload. The infusion rate should never be abruptly increased or decreased.
Bag and tubing need to be changed every 24 hours.

12. Complications of TPN Sepsis: infection Liver dysfunction
Respiratory distress from too –rapid infusion of fluids