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2010 cv annual ed central line care

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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

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  • 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.
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  • 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.
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  • 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).
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  • 35. Several Examples of proper application of transparent dressing .
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