CENTRAL LINE* Competency Questions
CENTRAL LINE* Competency
(* NOTE: This content does not apply to tunneled or long-term vascular access devices (e.g. Groshong, Hickman and PICC lines. Please refer to the relevant HMC policies and procedures related to these lines.)
This content will review the current HMC policy and best practices reported in the clinical literature. Central lines are a frequent source of nosocomial infection in all areas of the hospital. Checking the right patient, right procedure is one of the most basic, but vital methods of ensuring patient safety. Avoiding catheter-related infections is the responsibility of all members of the healthcare team and effects the insertion, maintenance and removal. Please note new additions to the previous standards are noted in italics.
Nurses and physicians should use proper hand hygiene (soap and water or hand gel) prior to inserting, accessing or dressing any central line.
INSERTION
|Pre-Procedure Verification |Prior to any elective line insertion the nurse and physicians should complete a pre-procedure check or “time out”. This is |
| |a brief pause that allows patient and procedure verification. It is also an opportunity to ensure that all needed equipment|
| |is present; that the patient is in the proper position and is pre-medicated if needed, which enhances patient safety during |
| |the procedure. |
|Site Selection |Routine use of femoral sits should be discouraged, as they are associated with higher rates of infection. The preference of|
| |order should be: subclavian, internal jugular then femoral. |
|Site Preparation |Sites should be prepped with a chlorhexidine preparation (Chloraprep). Dry areas should be cleansed for 30 seconds and |
| |allowed to dry for 30 seconds. Moist areas (e.g. inguinal folds) should be cleansed for 2 minutes and allowed to dry for |
| |1 minute. |
| |Chlorhexidine provides superior skin antisepsis than other agents such as Betadine. |
|Maximal Barriers |During line insertion, physicians should use maximal protective barriers, including sterile gloves, gown, mask and cap. |
|Adequate Resources during |Standardized line carts are being developed to ensure that adequate supplies are easily available during line insertion |
|Insertion |procedures. |
| |The nurse or their designate should be readily available during the entire procedure. |
| |If the nurse assisting notices a break in technique during insertion. They are empowered by the revised Central Line Policy|
| |to STOP THE PROCEDURE. |
MAINTENANCE
|Dressing Changes |Dressing changes should be completed every 24 hours or as needed when it becomes wet, soiled or non-occlusive. |
| |Nurses should use physical barriers including mask and gloves during dressing changes. |
| |The site should be closely inspected for signs of infection, then cleaned with a Chloraprep solution and then covered with a|
| |dry sterile dressing and tape. |
REMOVAL
|Daily Evaluation |The need for a central line should be evaluated on a daily basis at a minimum. Unnecessary lines should be removed |
| |promptly. |
1. Your patient in undergoing an elective line insertion. As the patient’s nurse your responsibility is to:
a. Complete the pre-procedure check section with the physician, and then take care of your other patient(s).
b. Complete the pre-procedure check section with the physician and ensure someone is available to assist with the insertion.
c. Let the physician complete the pre-procedure check section and be available to assist with the procedure as needed.
d. Assist with the line insertion as needed and evaluate the procedure using the pre-procedure check once the procedure is completed.
2. You are assisting with a difficult line insertion. During the procedure you notice that the resident
scratches his nose. Your next action should be to:
a. Stop the procedure. Inform him that he just broke the sterile field and needs to regown and glove.
b. Stop the procedure. Politely, but firmly let him know what you observed and get a new pair of gloves for him.
c. Document the infraction on the procedure checklist and let him finish the insertion.
d. Stop the procedure and call the Fellow to assist him with the insertion.
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