Blood Collection & Blood Culture Collection - PowerPoint Presentation

Slide1

Blood Collection & Blood Culture Collection

Removal

Preventing Infection

Needle-Free Valves

Insertion

Central Line BundleCare & MaintenanceTPNFlushes

Are central lines driving you crazy?



Slide2

What you need to know when a central line is necessary…

Slide3

Central Venous (Vascular) Access Devices: Insertion, Care and Maintenance, Blood Collection & Removal of [D-04], NPPM

St . Luke’s University Health Network

Annual 2014 Education for Nurses – updated 4/2014

Slide4

Significant policy & practice changes and reminders regarding central lines!

Prevent infections!

Best practice!

Why?

Slide5

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations...

Central Venous (Vascular)

Access

Devices

Central Line Bundle

Preventing Infection

Slide6

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

An

Informed Consent

shall be obtained for the insertion of central lines,

including PICCs, with the exception of emergency situations.

Secure ”

Central Line Insertion Form

” (#16264NP) to serve as guide and provide documentation of the insertion procedure (new attachment to policy).

Although this information should not be new to practice, the wording is new to the nursing policy.

Slide7

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Any

line inserted emergently

that was not placed under strict adherence to Central Line Bundle will be

labeled

, ”Emergent Line – insertion date: ____, time: ____.” Person inserting the line is responsible for labeling line accordingly. Typically the line should be

removed within 24 hours

of insertion.

Central lines inserted into the

femoral vein

should be

removed within 24 hours

of insertion unless otherwise directed by the physician.

24 HOURS ONLY

Slide8

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Any member of the health care team present during a central line insertion, including the nurse,

must

the process

if any aspect of the

Central Line Bundle process is not complied with

.

f

Slide9

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Central line sites

are

assessed

and site assessments are

documented

minimally upon first contact with the patient (e.g. at the beginning of shift, receipt of transfer, etc.) and with any changes or complications noted.

Assess site

for redness, swelling, warmth, tenderness, leaking, drainage, blood return, dressing integrity, etc.

Promptly report

any signs of infection or other complications, e.g.

c

atheter occlusion, to the physician.

Slide10

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

A

physician’s order is needed to access

a permanent venous access device, e.g.

Port-a-Cath

.

To access a

permacath

requires a

nephrologist’s

order.

Slide11

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Dressings are to be changed:

Every 7 days

or when the integrity of the dressing is compromised, loose, or soiled.

I

f

gauze dressing

is used,

every

2 days

or when the integrity of the dressing is compromised, loose or soiled.

PICC

–

24 hours

post insertion, then

every 7 days

.

Slide12

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Dressing

Change

Procedure

:

1

.

Perform

hand hygiene

.

2

.

Open

dressing kit, maintaining

sterility

.

3

.

Don

mask

(

self,

and

patient if unable to turn head to side away from catheter).

4

.

Put

on non-sterile gloves.

Remove

old dressing in the same direction as the

catheter

was inserted and discard with

gloves.

Perform hand hygiene

.

Assess

site for tenderness, redness, edema or

drainage.

Apply

sterile

gloves.

Cleanse

catheter insertion site with

chlorhexidine

following manufacturer's instructions for use. Allow to dry completely.

Apply

sterile dressing from kit.

Apply

label to dressing with time, date and

initials.

12.

Change needle-free valve(s) if no continuous or intermittent IV is infusing into lumen(s).

Please note…

Slide13

Flushes

Blood Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Reminders:

Any

central line

(including PICCs) inserted for the purpose of TPN

administration will have one lumen dedicated and

labeled

as follows:

“TPN-do not inject/withdraw

”.

Labeling is to occur immediately post insertion and is the responsibility of the person inserting the central line.

I

f

a nurse is starting TPN for the first time on an existing central line that has not been previously labeled, the nurse must attach the label to the lumen selected for TPN administration.

Slide14

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Needle-free valves

are to be

changed

:

With each

tubing change.

With

dressing changes when no continuous or intermittent IV is infusing

into a lumen.

Whenever the

integrity of needle-free valve is compromised.

When

residual blood remains

in the needle-free valve.

Slide15

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Question

:

What does this mean?

Needle-free valves

are to be

changed

with

dressing changes when no continuous or intermittent IV is infusing

into a lumen.

Answer

:

- If a lumen of a central line has a needle-free valve which is not being used for any IV infusion, the valve would not be changed because there would be no tubing changes...

- Therefore, the needle-free valve must be changed with the dressing changes.

Slide16

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Flush Protocol (attachment to policy) Updated:

Highlights practice expectations in policy.

Flush after blood draws standardized to

10 mL

normal saline.

Slide17

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice

Expectations

Central Line Bundle

Preventing Infection

Every effort should be made to

utilize the same port

each time a blood specimen is collected.

All IVs infusing into all ports of central venous catheters

must be stopped one minute

prior to specimen collection.

Vasoactive solutions should not be stopped.

Blood samples should

not be drawn from the lumen dedicated for TPN

.

Slide18

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

In order to maintain a closed system, blood samples should be

collected,

without removing the needle-free valve

, by using a vacutainer blood luer adapter and blood collection tubes OR syringe and blood transfer device.

Slide19

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Blood Culture Collection

:

A

central line should be used to obtain blood cultures only as a

last resort

,

and use for this purpose

requires a physician’s order

. (Exception: It is acceptable to obtain a blood culture upon insertion of a new central line.)

Prior to using a central line for drawing blood cultures, two (2) collectors should attempt a venipuncture on a patient.

If a blood culture is drawn from a central line, this must be done under

sterile conditions

and

the needle-free valve must be changed prior to draw

.

Further details are available in nursing and lab policies on MyNET.

Slide20

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

A

physician’s order is needed

prior to removing a central line.

Patient Care Units

, based on

patient population

, will determine the types of catheters that

validated RNs

will be allowed to remove. The validation process must be specific to catheter type. The following temporary catheters may be removed by validated RNs:

Introducer (e.g. Cordis)

Multi-Lumen Small Bore Catheter (e.g. Triple Lumen)

Multi-Lumen Large Bore Catheter (e.g. AVA)

Temporary Dialysis Catheter (e.g. Medcomp, Quinton)

PA Catheter (e.g. Swan Ganz)

Venous Sheath

PICC

RNs may

not

remove

the following catheters:

Tunneled Dialysis Catheters (e.g. Permacath)

Tunneled Catheters (e.g. Hickman, Groshong, Broviac, Tunneled Cuffed PICC)

Implanted Catheters (e.g. Port-a-Cath)

Slide21

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Should it be determined by the physician that the

patient is to be discharged with a central venous catheter in place

, a post-hospital plan for catheter care must be developed prior to discharge.

Slide22

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations...

Central Venous (Vascular)

Access

Devices

Central Line Bundle

Preventing Infection

Policy attachments now include:

Flush protocols – adult

Flush protocols – pediatrics

Central line insertion form

Procedure guidelines:

Blood withdrawal from central venous catheters

Obtaining blood cultures from central venous catheters

Central line removal

PICC line removal

Please view these attachments online when policy is released in January… The protocols and guidelines are great resources for practice

.

Slide23

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Ask daily, ”

Does

the patient really need a central line

??”

Remember

to

ALWAYS assess and reassess the patient for ability to insert peripheral access

.

Slide24

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Remember the

central line

bundles

!

Hand hygiene!

Aseptic technique

!

Insertion

bundle

Maintenance

bundle

Daily

line necessity

with

prompt removal

of unnecessary lines

Slide25

Flushes

Blood Collection & Blood Culture Collection

Care & Maintenance

Insertion

Removal

TPN

Needle Free Valves

Policy & Practice Expectations

Central Line Bundle

Preventing Infection

Patient Education Reminders

:

Use

Krames On-Demand

Always educate patients on central lines and preventing infection

When education is provided use

Teach Back

method to validate learning

Document

education provided

Slide26

No Central

Line Infections

TARGET ZERO – CAUSE NO HARM

EXCELLENT PRACTICE

HAND HYGIENE & ASEPTIC TECHNIQUE

CENTRAL LINE BUNDLES

Know it,

own it,

do it!

Slide27

Policy changes

go live date…

January, 2014 – Stay tuned for P & P Memo Release

Slide28

CL- CRZY

Don’t forget to take the test…

Thank you!