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CVC Care & Maintenance to prevent CR-BSIs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is a CR-BSI? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CR-BSIs ,[object Object]
Bloodstream Infections (BSIs) and Device Use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biofilm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sources of Contamination 1. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters.  Int Care Med . 2004;30:62-67. 1 Skin Organisms Endogenous- Skin flora Extrinsic-HCW hands 2 Contaminated Catheter Hub Endogenous-Skin flora Extrinsic-HCW hands 3 Contaminated Infusate Extrinsic-Fluid Medication Intrinsic-Manufacturer
Why is CVC care and maintenance so crucial ? I- Antibiotic resistance trends are likely to continue placing upward pressure on infection rates. 1  II- Accrediting agencies are now holding hospitals and their executives accountable for infection control. 2 III- CR-BSIs (Catheter Related-Blood Stream Infections) are a significant cause of hospital morbidity and  mortality.  3 IV- CMS (Centers for Medicare & Medicaid Services) will no longer reimburse for CR-BSIs due to recent changes. V- Most importantly our patients expect and deserve the best health care we can provide. 1. Wenzel, RP.  The impact of hospital-acquired bloodstream infections.  Emerging Inf Dis . 2001; 7(2):174-177. 2. Centers for Disease Control and Prevention.  Guidelines for the prevention of intravascular catheter-related infections.  Morbidity Mortality Weekly Report . 2002;51:1-29. 3.JCAHO, Hospital Program Infection Control Standards: Surveillance, prevention, and control of infection. 2005. 1-10.
Why is CVC care and maintenance so crucial ? ,[object Object],[object Object],[object Object]
Why is CVC care and maintenance so crucial ? ,[object Object],[object Object]
Why is CVC care and maintenance so crucial ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why is CVC care and maintenance so crucial ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why is CVC care and maintenance so crucial ? ,[object Object],[object Object]
CR-BSIs ,[object Object]
CDC Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CDC Recommendations   cont ,[object Object],[object Object],[object Object],[object Object],[object Object]
What can we do to prevent CR-BSIs? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What we can do to prevent CR-BSIs? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What we can do to prevent CR-BSIs? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What we can do to prevent CR-BSIs? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What we can do to prevent CR-BSIs? ,[object Object],[object Object],[object Object],[object Object]
a- Injection Caps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
b- Medication Administration ***ALWAYS WASH HANDS FIRST*** 1- Using aseptic technique, draw up medication to be given or spike IVF/IV ABX 2- Don clean exam gloves. 3- Open an alcohol pad. 4- Clean the injection cap with an alcohol pad for 15 seconds with a twisting motion like juicing an orange. Allow to air dry for 15 seconds. Do not fan or blow on the cap.
b- Medication Administration  cont ,[object Object],[object Object],[object Object],[object Object]
c- Flushing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
c- Flushing  cont ,[object Object],[object Object],[object Object],[object Object],[object Object]
What we can do to prevent CR-BSIs? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
V. Dressing changes   a-Scheduled & PRN.   ,[object Object],[object Object]
V. Dressing changes   b- Sterile Aseptic Technique.   ,[object Object],[object Object],[object Object],[object Object],[object Object]
V. Dressing changes   c- Removal of old dressing with site    inspection . ,[object Object],[object Object],[object Object]
V.  Dressing  changes   d- Thorough cleaning with antiseptic    skin prep. ,[object Object],[object Object],[object Object],[object Object],[object Object],Use repeated back-and-forth strokes of the applicator for approximately  30 seconds . Completely wet the treatment area with antiseptic. Allow the area to air dry for approximately  30 seconds . Do not blot or wipe away.
V. Dressing changes     e- Securing Your  PICC  After Cleaning.    (Skip this section if CVC is sutured.)   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
V. Dressing changes   e- Proper CHG disk application 1- Soft foam side to the skin “Foam To The Bone” 2- Foam side has the CHG 3- ”If you see white, the disk is not right”. 1-  BLUE  Side Up 2-  BLUE  to the Sky 3-  BLUE   side does NOT release CHG 1- Adequate distance between catheter hub &  insertion site. 2- 360 o  coverage around insertion site. 3- Slit at the 11 o’clock or 1 o’clock position  (shown here).
Several Examples of Properly Placed CHG Disk ,[object Object],[object Object],[object Object],[object Object],[object Object]
V.  Dressing changes  e-  Application of new dressing. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Several Examples of proper application of transparent dressing .
VI-  Proper Venous Access Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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2010 cv annual ed central line care

  • 1.
  • 2.
  • 3.
  • 4.
  • 5.
  • 6. Sources of Contamination 1. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Int Care Med . 2004;30:62-67. 1 Skin Organisms Endogenous- Skin flora Extrinsic-HCW hands 2 Contaminated Catheter Hub Endogenous-Skin flora Extrinsic-HCW hands 3 Contaminated Infusate Extrinsic-Fluid Medication Intrinsic-Manufacturer
  • 7. Why is CVC care and maintenance so crucial ? I- Antibiotic resistance trends are likely to continue placing upward pressure on infection rates. 1 II- Accrediting agencies are now holding hospitals and their executives accountable for infection control. 2 III- CR-BSIs (Catheter Related-Blood Stream Infections) are a significant cause of hospital morbidity and mortality. 3 IV- CMS (Centers for Medicare & Medicaid Services) will no longer reimburse for CR-BSIs due to recent changes. V- Most importantly our patients expect and deserve the best health care we can provide. 1. Wenzel, RP. The impact of hospital-acquired bloodstream infections. Emerging Inf Dis . 2001; 7(2):174-177. 2. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. Morbidity Mortality Weekly Report . 2002;51:1-29. 3.JCAHO, Hospital Program Infection Control Standards: Surveillance, prevention, and control of infection. 2005. 1-10.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. b- Medication Administration ***ALWAYS WASH HANDS FIRST*** 1- Using aseptic technique, draw up medication to be given or spike IVF/IV ABX 2- Don clean exam gloves. 3- Open an alcohol pad. 4- Clean the injection cap with an alcohol pad for 15 seconds with a twisting motion like juicing an orange. Allow to air dry for 15 seconds. Do not fan or blow on the cap.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32. V. Dressing changes e- Proper CHG disk application 1- Soft foam side to the skin “Foam To The Bone” 2- Foam side has the CHG 3- ”If you see white, the disk is not right”. 1- BLUE Side Up 2- BLUE to the Sky 3- BLUE side does NOT release CHG 1- Adequate distance between catheter hub & insertion site. 2- 360 o coverage around insertion site. 3- Slit at the 11 o’clock or 1 o’clock position (shown here).
  • 33.
  • 34.
  • 35. Several Examples of proper application of transparent dressing .
  • 36.