Show:
Central Line Maintenance Bundles
Pressure Ulcer Prevention Bundle
CAUTI Prevention Bundle
CICU/PICU VAP Prevention Bundles
Bags and Tubing and Claves, Oh My!
100
The single best way to prevent the spread of infection.
What is handwashing?
100
The minimum frequency that mobility-challenged patients of any age should be repositioned. (Which includes most of our patients!)
What is every 2 hours. Remember that "mobility challenged" can include stubborn 12 year olds with normal sensation that don't want to move (and won't!) at all after their surgery. Pay especially close attention to unconscious, paralyzed, sedated, and numb patients. Your patients are counting on you to carefully resposition them and protect them from laying on harmful objects in their bed! Tip: Use a TAPS kit for larger patients for both your and your patient's safety and comfort. You can ask for one from Materials if your patient doesn't already have one.
100
By always using strict ________ when you insert urinary catheters, you can greatly help prevent CAUTI's.
What is strict sterile technique? If you are unsure about how to insert a Foley Catheter with perfect sterile technique or haven't done one for a while, DON'T proceed in the face of uncertainty. There are many ways to ask clarifying questions and check your knowledge. Ask your educators for a refresher, review CPG, review previous MyLearning modules that take you through the procedure step by step, utilize the unit's charge nurse or a more experienced pod partner--do whatever you need to do to do it correctly. There is no such thing as being too careful or asking too many questions in nursing. After all, we all just want to do what is best for the patient!
100
What should we do to the ventilated patient's bed to help prevent Ventilator-Associated-Pneumonia (VAP)?
What is raise it up to 30 degrees, 12 degrees if infant
100
It is very important to do a sterile clave change right before getting which lab test from your patient's central line? Bonus question! True or false: drawing routine labs from a clave requires you to do a sterile clave change every 24 hours.
What is a blood culture. What is FALSE! We don't want to draw blood cultures from a dirty clave--that could give us inaccurate results and lead to inappropriate patient care.
200
It's time to change your patient's pediatric central line dressing when _______ (list the routine reason and three other reasons).
What are: when the dressing is 7 days old, or the dressing is loose (non-occlusive), damp, or soiled. FYI - If a gauze dressing is used, routinely change the dressing every 2 days (or more frequently if the dressing is loose, damp, or soiled.)
200
This medical device circulates air under a patient and helps prevent skin breakdown.
What is an Accumax Bed Pump. FYI- These are easily found in most storage rooms. Also try calling materials or the Wound Team if you can't find one. You DO NOT need a doctor's order to start this excellent intervention! It is especially useful for moist, fragile skin.
200
This has been a Foley-Catheter related issue between ICS nurses and techs that was mentioned in one of our recent weekly updates.
What is double charting of urine output. Make sure that you are either measuring the urometer front collection chamber output OR the emptying and measuring what is in the bag. Do not chart both, or your patient could have inaccurate I's/O's. Make sure you have a pod huddle at the beginning of the day to clear up any confusion this may cause for your tech or other pod partners.
200
To help prevent VAP, what 2 additional times (besides when they obviously need it) should we suction our vented patients' airways?
What is before turning our patients or before cuff deflation.
200
Propofol (a sedative used for procedures and in the ICU) is the only medication/solution that, after it is given in your patient's central line, requires a container change, IV tubing change, and sterile clave change after ____ hours (hint: all the same number).
What is 12 hours. Remember, with a few exceptions (that we will cover in this presentation), most claves should be changed every 96 hours.
300
The frequency that a newborn's unsutured neo-picc dressing needs to be changed.
What is only when needed. (This is not done routinely unless the dressing is loose, damp, or soiled. Seek assistance from your NICU Charge Nurse.)
300
A medical device at high risk for causing skin breakdown; skin underneath must be assessed once a shift and washed daily.
What is a C-Collar.
300
The CAUTI bundle states that this is the correct frequency and method for doing proper Foley Catheter Care.
What is washing the patient's perineum and Foley Catheter with Soap and Water once per shift. To wash the Foley Catheter: stabilize it with one hand, then wash the catheter starting at the patient's urethral meatus moving away from the patient down the circumference of the tube.
300
Proper oral care is huge for VAP prevention. What product can we NOT use for our immunocompromised patients that we routinely use for our patients with and without teeth?
What are sage products. The oral care should be modified for immunocompromised patients that have mucositis 1. Pink swabs 0800-2000 2. Biotene 5 mL on pink swab followed by Nystatin 15 mL on pink swab 1200-1600-2400-0400 3. Do not use Sage Products
300
Blood / Blood products requiring a filter (e.g., PRBCs, FFP, platelets) require an IV Solution Container Change every ___ hours, an IV tubing change every ___ hours, and a clave change every ____ hours.
What are: 4, 4, and 24. FYI: Blood products that DON'T use a filter (like albumin or gammaglobulins) need a container change every 4 hours, an IV tubing change every 24 hours (instead of 4 hours with a filter), and a clave change at 24 hours (same as with a filter).
400
Name the proper length of time for scrubbing a central line insertion site during a sterile routine dressing change.
What is: 30 second CHG scrub, 30-60 second dry for insertion site Exception - 2 minute scrub 60 second dry time if catheter is in groin FYI - CHG may be used for all ages, including infants. FYI - Alcohol swab does not have a fixed scrub time, and is there to help clean off encrusted blood, etc.
400
The area of skin under these devices is often overlooked, and is a common site for pressure ulcer formation in the Pediatric population.
What is under a PIV hub. Make SURE that your PIV's are padded and use HubGuards under the Hub. Also point the winged phalange on the PIV Hub upwards instead of downwards, where it is pressed into your patient's skin. This should be checked whenever you assess your patient's PIV, but ESPECIALLY when you trace lines. Imagine if a serious pressure ulcer was discovered under a PIV that you charted you had assessed and traced lines on regularly--it would look like you didn't do a very thorough job, and you would be partly responsible for the ulcer.
400
Asking yourself (and the team) this one simple question can help drastically reduce CAUTI's.
What is "Does my patient really need this catheter?" If not, see if the team is okay with writing an order to have you remove it. Prevention is key!
400
Part of the VAP bundle states that we should: Evaluate our patient's level of _______ (1 word) daily. Evaluate our patient's ongoing need for ________ (2 words) daily.
What are sedation and mechanical ventilation. Again, prevention is key! The sooner the patient is no longer ventilated the less likely he or she is to contract ventilator-associated pneumonia.
400
A TPN bag is only good for ___ hours, but the tubing and clave are good for ____ hours. A lipid container is only good for ____ hours, and the clave is only good for _____ hours.
What are 24 hours and 96 hours; 12 hours and 24 hours.
500
Name at least 4 out of 5 categories of "central lines" included in this bundle.
What are: 1) Tunneled CVC (Broviac, Cook) 2) Implanted port 3) PICC (Regular, Pediatric, or Neo) 4) Dialysis catheter 5) Temporary CVC (femoral, jugular, subclavian)
500
The three main body parts the Pressure Ulcer Prevention Bundle expects all nurses to assess every shift for every patient.
What are the heels, occiput, and coccyx?
500
List three ways to prevent urine from building up in or re-entering the bladder when a patient has a Foley Catheter.
What are: *Keeping the tubing free from kinks, dependent loops, or obstructions. *Keeping the drainage bag below the level of the bladder at all times (NOT touching the floor). *Empty the urine collection bag at the end of every shift, prior to transporting, or when it is 1/2 full (so non-sterile urine does not flow back up the catheter and introduce bacteria into the bladder).
500
Again, proper oral care is a huge part of the VAP prevention bundle! What oral care products should we use and how often should we use them for our ventilated patients who have teeth?
What are: i. Teeth brushing q12 hours with Sage ™ toothbrush and antiplaque solution (0800, 2000) ii. Green Sage™ product q 4 hours (1200, 1600, 2400, 0400) (Notice we don't need to use the pink swabs routinely for our non-mucositis patients who have teeth.) FYI--For patients WITHOUT teeth: i. Clean oral cavity with pink swab and sterile water or saline q12 hours (0800, 2000) ii. Green Sage™ product q 4 (1200, 1600, 2400, 0400)
500
Regular, premixed crystalloid solutions from the storage room only require a bag change, IV tubing change, and clave change how often? ____ hours (same number). If something is mixed in with the bag from pharmacy, change it every ____ hours, but the clave and IV tubing are still good for ____ hours. Bonus question! Any IV solution/IV tubing being used INTERMITTENTLY (i.e. turned off or disconnected for more than an hour or two--use your clinical judgement) needs to be changed every ______ hours.
What is 96 hours, 24 hours, 96 hours. Bonus: 24 hours. FYI: Change Chemotherapy tubing every 24 hours (unless it is going over several days continuously), but the clave is still good for 96 hours.