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Prevention of Central LineAssociated Bloodstream

Infections (CLABSI)

What is a Central Line?


A central line is an IV (intravenous) line that

goes into a large blood vessel near the


center of the body.
Central lines are used for giving medications,

fluids, IV nutrition and drawing blood.

Why do I need one?


A central line may be considered necessary for the following:
long-term

antibiotics or multiple IV antibiotics


blood products
Vesicant drugs (Vesicants cause blistering
and other tissue injury that may be severe
and can lead to tissue death) or irritant drugs
(drugs that will irritate veins)
TPN (total parenteral nutrition)
chemotherapy
hemodynamic monitoring
reliable access (IV fluid therapy, frequent
blood draws, pain management).

What types of central venous


catheters are there?
There are several types of central venous

catheters.
PICC line- A peripherally inserted central

catheter, or PICC line (pronounced "pick"), is


a central venous catheter inserted into a vein
in the arm rather than a vein in the neck or
chest.

Types of Central Lines-1

This type of catheter is


surgically inserted into a vein in the neck or
chest and is passed under the skin. One end
of the catheter remains outside the skin.
Passing the catheter under the skin helps
keep it in place better,
lets you move around
easier, and makes
it less visible.
Tunneled catheter-

Types of Central Lines-2

This type is similar to a


tunneled catheter but is left entirely under the
skin. Medicines are injected through the skin
into the catheter. An implanted port is less
obvious than a tunneled catheter and
requires very little daily care. It has less
impact on a person's activities than a PICC
line or a tunneled catheter.
Implanted port-

Types of Central Lines-3


Using an Implanted port-

How do central lines cause Central


Line Associated
Blood Stream Infections (CLABSI)?
Central venous catheters (CVCs) disrupt the
integrity of the skin allowing bacteria and/or
fungi to enter.
Infection can spread into the bloodstream

(bacteremia)
Hemodynamic changes and organ dysfunction

(sepsis) may follow.

CLABSI Definition
CLABSI is the term used by the US Centers for

Disease Control and Preventions (CDCs) National


Healthcare Safety Network (NHSN)9 (see NHSN
CLABSI information). A CLABSI is a primary
bloodstream infection (that is, there is no apparent
infection at another site) that develops in a patient with
a central line in place within the 48-hour period before
onset of the blood-stream infection that is not related to
infection at another site.

Path of Infectious Agents

Caring for your Central Line-1

A home care infusion company will give you the supplies needed to
care for the central line at home.

The central line is flushed daily to keep it from clotting. You are taught
how to do this by a nurse from your home care infusion company.

Change the dressing and cap weekly. Also change the dressing if it
comes loose and is no longer covering the exit site. A nurse will do
this until you are trained to do so.

Caring for your Central Line-2

There may be some bleeding after surgery and a dressing change


may need to be done sooner than one week.

Keep the central line safe by using the securing device supplied by
the home care infusion company and avoid tugs or pulls on the line.

Anyone else caring for your child, such as babysitters and teachers,
will need to learn central line safety and emergency care.

Signs and Symptoms of infection:

Nonspecific
Fever
Chills, shaking rigor
Hypotension, shock
Hyperventilation
Gastrointestinal

abdominal

Highly Suggestive of
Line Sepsis

pain

Vomiting

Diarrhea

Neurologic
confusion
seizures

Signs &
symptoms

Source of sepsis unknown


Patient not likely candidate
for sepsis
Intravascular line in place
(or recently in place)
Inflammation or drainage
at site
Abrupt onset, as with shock
Sepsis responds to
antimicrobial therapy or
observable patient
improvement of s/s* after
removal of device

How to prevent a CLABSI

Ensure the patient, family and caregivers are educated about


central line infection prevention prior to the insertion of the
line.

Demand Strict Hand Hygiene

Observe proper hand washing procedures with antisepticcontaining soap and water before you or anyone
accesses your line.

Dressing Changes-1
Replace the catheter dressing if it becomes damp,

loosened, or visibly soiled or when you need to inspect the


site as necessary.
Dressing changes are to be done based on your facilitys
policy and line type.
Chlorhexidine is the preferred cleansing agent. When
cleansing the dressing site, use chlorhexidine (CHG) swab
or other approved agents per your facilitys policy.

Dressing Changes-2
Do not use topical antibiotic ointment or creams

on insertion sites.
Do not submerge the catheters under water.
Visually inspect site for swelling, erythema (redness)
or drainage. If any of these symptoms are present notify your
physician.
Do not use acetone or adhesive remover to remove old
dressings.
Transparent dressing material will release when stretched.

Chlorhexidine Alert . . .
Chlorhexidine should not be used as a skin
prep for:
Infants less than 2 months of age

Anyone with a chlorhexidine sensitivity or allergy.


10% povidone-iodine or 70%

alcohol may be used as an


alternative skin prep.

Provide optimal care for IV


Injection Ports

Before accessing your port, clean it


per the manufacturers guidelines

(10 twists with 70% alcohol)

and allow it to air dry before


accessing the system. (Do not blow
on it or fan it).
Cap all central line ports when not in
use.
Change caps no more frequently
than every 72 hours and at least
every 7 days or according to the
manufacturers recommendations.

Caution: change the cap when it has been removed for any reason or
any time the cap appears damaged, is leaking, blood is seen in the
catheter without explanation, blood residue in the cap or when cap has
been laid down on a non-sterile surface.

References

Center of Disease Control (2011).


Guidelines for the prevention of
intravascular catheter-related
infections. Retrieved from:
http://www.cdc.gov/HAI/bsi/bsi.html

Institute for Healthcare Improvement


(2015). Retrieved from:
http://www.ihi.org/IHI/Programs/
Campaign/CentralLineInfection.htm