2. Disclosures
• Teleflex
Ultrasound-­‐guided
central
venous
&
arterial
access:
compliance
within
prac=ce
–
Faculty
Member

3. What
we
already
know
• Currently,
nurses
provide
majority
of
care
to
VADs
• >
~95%
hospital
admissions
will
have
some
form
of
VAD
within
24hr
of
admission
• OSen
first
line
of
management
during
any
given
hospital
admission
-­‐
ER
• Vascular
access
procedures
are
the
most
commonly
performed
invasive
procedure
in
the
world
today.

4. What
we
already
know
• With
that
knowledge,
clinicians
need
to
be
aware
of
the
types
of
CVCs
available,
the
advantages
and
disadvantages
of
each
type,
and
how
catheter
selec=on
and
implementa=on
of
recommended
preven=ve
strategies
can
impact
the
CRBSI
rate.
• These
devices
and
strategies
work
together
as
a
collabora=ve
approach
but
cannot
individually
provide
the
significant
impact
needed
to
affect
CRBSIs.

5. Typical
ICU
trauma
pa=ent;
~
mul=-­‐infusion
therapy
~
mul=ple
wounds
Portals
for
cross-­‐infec=on?

6. Early
Assessment
• Selec=on
of
device(s)
based
on
a
needs
assessment
• Minimises
the
need
for
inappropriate
devices
• Ongoing
monitoring
is
essen=al
• Products/device
review
and
analysis
• Defining
terminology
and
repor=ng
outcome
measures

7. The
powers
of
observa=on..
Shoe
leath
er
surveillanc
e
is
the
best
form
of
monitorin
g

8. Interven=on
• Preven=on
of
infec=on
• Maintaining
a
closed
IV
system
• Maintaining
a
patent
device
• Preven=ng
damage
to
the
device
(Malleb
and
Bailey
1996)
• Surveillance,
management,
and
leadership
following
project
implementa=ons

9. CRBSI
or
CLABSI?
Confused
yet?

10. CDC
says
what..
• CRBSI
criteria
require
one
of
the
following:
– A
posi=ve
semi
quan=ta=ve
(>15
colony-­‐forming
units
[CFU]/catheter
segment)
or
quan=ta=ve
(>103CFU/
catheter
segment)
cultures
whereby
the
same
organism
(species
and
an=biogram)
is
isolated
from
the
catheter
segment
and
peripheral
blood
– Simultaneous
quan=ta=ve
blood
cultures
with
a
≥5:1
ra=o
CVC
versus
peripheral
– Differen=al
period
of
CVC
culture
versus
peripheral
blood
culture
posi=vity
of
>2
hours

11. • A
CLABSI
as
defined
by
CDC,
is
a
primary
(i.e,
no
apparent
infec=on
at
another
site)
BSI
in
a
pa=ent
that
had
a
central
line
within
the
48-­‐hour
period
before
the
development
of
the
BSI.
BSI
is
defined
using
either
laboratory
confirmed
bloodstream
infec=on
(LCBI)
or
clinical
sepsis
(CSEP)
defini=ons
• In
the
CDC/NHSN
defini=on
of
CLABSI,
there
is
no
minimum
period
of
/me
that
the
central
line
must
be
in
place
in
order
for
the
BSI
to
be
considered
central
line–associated.
• The
culture
of
the
catheter
-p
is
not
a
criterion
for
CLABSI!

12. Involving
people..
• While
most
facili=es
have
tradi=onally
disseminated
infec=on
data
to
hospital-­‐wide
commibees
and
administra=on,
it
is
essen=al
to
also
share
this
informa=on
with
the
people
who
can
actually
make
a
difference—the
direct
care
providers.
Involving
proceduralists
who
place
the
central
venous
catheters
provides
valuable
feedback
on
poten=al
technique
issues.

13. Maximal
barrier..

14. Products
• Analysis
of
specific
types
of
products,
(e.g.
catheters,
valves,
site
dressings,
fluid
bags,
accessory
products),
con=nues
to
have
benefit.
• But
the
true
value
of
a
specific
product
is
best
recognized
in
rela=on
to
all
products
that
make
up
the
pa=ent’s
IV
system.

15. Educa=on
and
training
• Mul=ple
studies
have
demonstrated
improvement
with
educa=on
and
training
• Physicians
have
currently
no
creden=aled/
standardized
method
for
learning
catheter
inser=on
• Many
nurses
have
very
lible
exposure
to
principles
and
prac=ces
of
catheter
management
• See
one,
do
one,
teach
one
method
is
NOT
an
adequate
educa=onal
tool!
• Mul=disciplinary
group
to
create
educa=onal
plan

16. Preven=ons
matched
with
source
of
organisms
Skin
• Hand
hygiene
• Skin
an=sepsis
• Inser=on
site
• Maximal
barriers
• Catheter
stabiliza=on
• Dressings
• An=microbial
catheters

17. Preven=ons
matched
with
source
of
organisms
Infusate
• Single
use
flushing
system
• Laminar
air
flow
work
bench
• Strict
adherence
to
asep=c
technique
when

18. Preven=ons
matched
with
source
of
organisms
Catheter
hub
manipula=on
• Hand
hygiene
• Number
of
catheter
lumens
• Hub
an=sepsis
• Tubing
and
cap
changes
• Flushing
procedures
• An=microbial
catheters
• Needleless
injec=on
devices

19. Who’s
who
in
the
zoo!
• Reducing
CRBSI
is
EVERYONES
business,
not
just
one
clinician
specialty
• Nurses,
physicians,
respiratory
therapists,
technicians,
as
well
as
pa=ents
themselves,
take
the
responsibility
to
prevent
infec=ous
complica=ons
through
constant
vigilance
in
monitoring
the
device
Its
not
your
-tle,
but
it’s
the
difference
you
make
at
the
bedside
that
counts

21. Tim.Spencer@sswahs.nsw.gov.au
• Webcast
was
to
share
knowledge
and
best
prac=ces
on
IV
therapy
management
including
CLABSI
preven=on
and
beyon
hbp://vioca.st/Andrew_Jackson_Infec=on_Preven=on_IV_Management_Educa=onal_Webcast