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Central Line Maintenance Learning Objectives • Review the evidence and recommendations for central line maintenance Slide 2 Source of Recommendations • Centers for Disease Control • Society for Healthcare Epidemiology of America • Infectious Diseases Society of America Slide 3 Overview of Recommendations Central line maintenance recommendations address the following topics: • • • • • • • Central line insertion Central line dressing changes Replacement of IV administration sets Hang time for parenteral fluids Catheter hub cleansing Removal of unnecessary lines Education Slide 4 Central Line Insertion • Ensure use of checklist • Empower nurses to stop the procedure if the steps in the checklist are not followed • Leadership must create a culture that supports nurses Slide 5 Central Line Dressing Change Dressing change responsibility includes only those who have demonstrated competency: • Nursing personnel including PICC teams and nurse practitioners • Medical personnel including physicians and physician assistants Slide 6 Central Line Dressing Change Frequency: • Transparent dressing – Every 7 days – PRN if damp, loosened, or soiled • Gauze dressing – Every 48 hours for routine use Slide 7 Replacement of IV Administration Sets • Lipids and blood products (enhance bacterial growth) – Change every 24 hours • All other IV administration sets – No more frequently than every 72 hours – Not more than every 96 hours Slide 8 Hang Time for Parenteral Fluids • Lipid-containing parenteral nutrition – Change every 24 hours • All other IV fluids including nonlipid-containing parenteral nutrition – No formal recommendations – JHH changes nonlipid-containing IV fluids every 24 hours Slide 9 Catheter Hub Cleansing • Clean hub before accessing with Chlorhexidine or 70% alcohol • No formal recommendations regarding how long to cleanse hub Slide 10 Remove Unnecessary Lines • Assess need for continued central line access during daily multidisciplinary rounds – Add question to a Daily Goals worksheet – Complete every day during rounds Slide 11 Education Educate all necessary staff: • Guidelines to prevent catheter-related bloodstream infections • Use of central line checklist • Proper insertion and maintenance of central lines Ensure competency through yearly education and examination Slide 12 References • Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control and Hospital Epidemiology. 2008; 29 (supp. 1):S22S30. • O’Grady NP, Alexander M, Dellinger P, et al. Guidelines for the prevention of intravascular catheter-related infections. Infection Control and Hospital Epidemiology. 2002; 23(12):759-769. Slide 13