Occluded lines can lead to delayed therapies, increased length of hospital stay, and other related issues. Occlusions are caused by inadequate flushing after incompatible medications, blood draws, and blood product administration.
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“A competency for obtaining both peripheral and central blood cultures should be in place for staff training to avoid contamination.”įrequent flushing of a catheter keeps it free from blood and debris and reduces the chance for CLABSI.
“A blood culture policy should be in place to guide ordering and procurement of blood culture,” Olsen said. Strict sterile technique must also be used when obtaining blood cultures.
Effective IV tubing strategies include minimizing add-on devices, maintaining a closed system, utilizing back priming, and never looping tubing back into another port. IV tubing contamination leads to CLABSIs, Olsen explained. When dressing, any sign of blood should be met with zero tolerance and can be prevented or mitigated with best practice techniques.
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Olsen said that a highly permeable dressing with appropriate skin prep (CHG as the first choice) helps to prevent dressing disruptions. Alcohol swabs are important for passive continuous disinfection but are not a substitute for frictional scrubbing, she cautioned.ĭressings that are transparent, dry, clean, and intact reduce the risk for CLABSI. Change the connectors with each tubing change, every 96 hours when not accessed, or if they contain visible blood or debris. Needleless connectors and hubs should be scrubbed clean before every access. Use CHG daily to prevent pathogens and as an alternative to bathing with soap and water, Olsen said. Never connect used IV tubing to new central line. After insertion, confirm tip location by chest x-ray or electrocardiogram. Midline catheters are placed in the middle of the arm and not in the subclavian. “Optimal placement of a central venous catheter can lead to catheter longevity and decrease complications such as thrombus, malposition, and dislodgment,” Olsen said.Ĭentral lines are exclusively placed in the superior vena cava, ideally at the superior vena cava–right atrial junction. And catheter tip location is critical and a major factor in reducing complications. “This person should be empowered to speak up if any step of the procedure is compromised or not completed.” Catheter Placementīefore inserting a central line, Olsen said to prep the skin with chlorhexidine (CHG), which is more effective in preventing CLABSI than povidone-iodine. “Checklists should be completed by an observer who is trained and not part of the insertion process,” she said. To prevent central line–associated bloodstream infections (CLABIs) and other complications, Olsen said that an evidence-based central line checklist is a key tool for oncology nurses.
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