If you or your loved one are in the hospital or nursing home, you may need to have a procedure done that allows fluids or blood to get into your bloodstream quickly called a central line or central venous catheter (CVC). This procedure works like an IV, but is placed in larger veins (e.g. neck, upper chest, leg). It is important for you to make sure if you must have a CVC placed, that the CVC is cleaned properly and is taken out when it is no longer necessary. Central lines can become infected and then cause your blood to become infected. Blood stream infections are very serious and can cause death, particularly if you have other health conditions that weaken your immune system. The Pennsylvania Patient Safety Authority has analyzed data from Pennsylvania hospitals regarding central line associated bloodstream infections (CLABSIs). Pennsylvania hospitals are above the national average in regard to preventing CLABSIs, however analysis shows hospitals may not be following the steps needed to ensure CLABSIs are prevented as much as possible and even eliminated. Please educate yourself and your loved ones on CLABSIs so you can help prevent a serious and sometimes deadly infection.
(Provided by the Institute for Healthcare Improvement (IHI) and the Centers for Disease Control and Prevention [CDC])
What is a central line?
A central line or central venous catheter (CVC) is a long hollow tube similar to the intravenous lines placed in a patients’ arm except that they are placed into larger veins found in the patient’s neck, upper chest, leg or arm. It can remain in place in some cases for several weeks. Central lines are used to give large amounts of fluid or blood quickly, and to give special nutrition when foods or liquids can’t be given through the gastrointestinal system. They are also used to give medicines that can only be given through large veins or medicines that must be given by IV for a week or longer.
What is a central line-associated bloodstream infection?
Infection can occur when bacteria grow in the line and spread into the bloodstream. This is called a “catheterrelated bloodstream infection” (CLABSI). If you have a temperature above normal, fever, chills, or the skin around the CVC is painful, red, swollen or oozing, this could indicate the beginning of an infection. These serious, sometimes deadly infections can often be successfully treated with antibiotics. Sometimes the only way to cure the infection is to remove the catheter.
What are hospitals doing to prevent CLABSI?
Doctors and nurses can help prevent CLABSI by using all of the following steps:
- Everyone who touches the central line must wash their hands with soap and water or an alcohol-based hand sanitizer before inserting the catheter, changing the bandage, or touching the catheter to take blood or to give medications.
- The person who inserts the line should wear a mask, hair covering, sterile gown and sterile gloves.
- The patient should be fully covered with a large sterile drape.
- The patient’s skin should be cleaned with an antiseptic skin cleanser when the line is put in and when the dressing is changed.
Choose the best vein to insert the line where the risk for infection is small. Often, this is the subclavianvein (in the chest) which is not as likely to get an infection as veins in the arm or leg.
Check the line for infection and decide every day if the patient still needs to have the catheter. The catheter should be removed as soon as it is no longer needed.
What can patients and family members do to help prevent CLABSI?
In the Hospital:
- Ask your doctors and nurses if they are using the steps listed above to lower your risk of infection.
- Tell your nurse right away if the bandage is loose, soiled, or wet, or if the skin around the catheter is sore or red.
- Watch that your doctors and nurses wash their hands before and after giving you care.
- Make sure that your visitors do not touch the catheter or the tubing.
- If you go home with your catheter make sure your doctors and nurses explain how to care for your catheter and who to contact if you have questions.
- To prevent infection your central line must be kept clean and dry at the exit site, where it comes out of your skin, and also at the end.
A transparent dressing will cover the exit site while the stitches are in place. If the wound appears clean and dry the dressing should be changed once a week. After the wound has healed, the stitches will be removed. While a dressing will no longer be needed at the time the wound has healed, the line must always remain looped and secured with tape.
For more information on prevention of central line infections, go to the 2010 March Supplementary Pennsylvania Patient Safety Advisory article “Beyond the Bundle: Reducing the Risk of Central Line-Associated Bloodstream Infections” at the Authority’s website at www.patientsafetyauthority.org or click here.