Certification of Central Venous Lines

Certification of Central
Venous Lines
Georgia Health Sciences Medical Center
Augusta, Georgia
November 13, 2012
The Joint Commission
National Patient Safety Goal #7
“Reduce the risk of healthcare associated
Implement best practice or evidence based
guidelines to prevent central line associated
bloodstream infections.
Elements of the Central Line Bundle:
 Hand hygiene
 Maximal barrier precautions upon insertion
 Chlorhexidine skin antisepsis
 Optimal catheter site selection, with avoidance
of using the femoral vein for central venous
access in adult patients
 Daily review of line necessity, with prompt
removal of unnecessary lines
What is a “Certified Line”?
 Inserted by a “Qualified Inserter”
 Witnessed by a “Qualified Observer”
 Having at least 2 people present at all times during the insertion
 Verified by the “Qualified Observer” through
documentation in the medical record that:
 All components of the CVL Bundle were followed, and
 No breaks in sterile/aseptic technique occurred
 Documented as “certified” in the medical
record by the “Qualified Observer”
 All components of the bundle must be followed with no breaks in
sterile/aseptic technique.
 NOTE:If components of the “bundle” are not adhered to,
documentation by the “Qualified Inserter” indicates appropriate reason
deviation occurred and can still be certified.
“Certified Line”
“Qualified Inserter”
“Qualified Observer”
(A non-certified line should be removed
within 24 hours of insertion.)
Who is a “Qualified Inserter”?
A Physician, PA or Advanced Practice RN who
has met these two criteria:
 Successfully checked off by their service as competent
in the insertion of central lines and credentialed for
CVL insertion
 Successfully demonstrated competent use of the CVL
Bundle by attending the CVL Bundle Program
sponsored by Hospital Epidemiology
Who is a “Qualified Observer”:
 Vascular Access Teams (AVAT/PVAT)
Pediatric and Adult ICUs
General Nursing Units
 Registered Nurses in:
Interventional Radiology
Emergency Department
Operating Rooms (circulating nurses)
Critical Care Units
Pediatric Units
Adult Vascular Access Team AVAT
 13 members
24/7 Coverage
 Preferred first contact for central line
insertion observation
 Routine maintenance for all central lines
 Insertion of PICC lines
Pediatric Vascular Access TeamPVAT
 8 PVAT members
 CMC Coverage
 Preferred first contact for central line
insertion observation
 Routine maintenance for all central lines
 Insertion of PICC lines
Computerized Physician Order Entry(CPOE)
Activates the VATs
CPOE Continued
CVL Bundle Program
Consists of:
 1 hour didactic class
 National Patient Safety Goals
 Central Line Bundle
 Hospital Policy
 Policy access on the intranet
 Basic Asepsis within surgical field
 Competency demonstration in a simulated lab
 Skills assessed:
 Surgical scrub / Donning sterile attire
 Skin prep / draping / Central Line Bundle
 Dressing & antimicrobial disc application
 Documentation of insertion and bundle
 Access to policies/procedures on line
CVL Bundle Program
Upon successful completion of the program a badge
is given to identify them as a “Qualified Inserter”
Next Step
Incorporate “Qualified Inserter” verification into the
Procedure Time Out process and documentation using
the “red” Asepsis (CVL Bundle) Program badge.

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