Root cause 1
The skin barrier is traumatized the most with this technique of hair removal
What is shaving?
In this patient population subclavian line placement may be challenging as a shorter needle may not be deep enough to access the vessel
What is patients with high BMI (over 35)?
A 52 year-old male is admitted to the medical ICU for acute respiratory failure secondary to pneumonia. He has a left internal jugular CVL and has developed continued bleeding from around the CVL because of this.
What is coagulopathy?
Strict adherence to sterile techniques is especially important for these patients during central line placement is crucial to prevent infections.
What is immunocompromised patients?
This type of dressing should be applied to CVL insertion sites
What is transparent CHG-impregnated dressing
Nicks and cuts can serve as entry points for pathogens if this is not done correctly
Why should hair clipping be done carefully?
This equipment/technique can help line placement in patients with obesity
What is ultrasound guided central line placement?
Patients with active bleeding from CVL should have this done.
What is assessment and management of coagulopathy?
A 35 year-old female with NASH cirrhosis POD1 s/p orthotopic liver transplant. She has developed severe acute kidney injury and requires Quinton placement for CRRT. This strategy should be considered with CVL placement in this immunocompromised patient.
What is the use of maximum sterile barrier precautions?
Handwashing should occur for this length of time, prior to CVL insertion
What is minimum of 20 seconds or use of avaguard
This thing can make it hard for the central line dressing to adhere to skin
What is a beard?
This line position is associated with a higher risk for infection in obese patients
What is femoral line?
This technique can reduce the risk of puncture attempts and bleeding complication rates
What is ultrasound guidance to place central lines?
Selection of access sites at lowest risk of infection is very important for these patients.
What is immunocompromised patients?
This type of drape is necessary for CVL placement.
What is full body drape
A 54 year-old male with a history of severe COPD is POD 2 s/p low anterior resection for colon cancer. He develops anastomotic leak and progresses to septic shock. He is on increasing vasopressor support with only two 18g PIVs. You plan for 7fr triple lumen CVL placement. He has a large neck beard. This technique may help facilitate safe line placement.
What is proper hair clipping?
This maneuver can help during line placement for patients with high BMI (>35)
What is a second provider in sterile PPE to retract skin folds?
These things can be done to limit bleeding from central line sites.
What are limiting stab incision size at insertion site and application of gauze/approved topical hemostatic agents?
This topical agent is especially important when preparing to insert a central line in immunocompromised patient.
What is alcoholic chlorhexidine solution?
All hubs/ports of the CVL should be covered with these
What are antibiotic and/or alcohol impregnated caps
In a patient with a beard/lots facial hair this technique may reduce infection risk
What is subclavian line insertion?
This is a challenge of femoral line placement in obese patients.
What is a pannus?
There is a lack of strong supportive evidence for this pre-procedural assessment and correlation.
What is identification and correction of coagulopathy?
These patients are at increased risk of serious complications/mortality from CLABSIs.
What is immunocompromised patients?
CVLs with continued bleeding should be dressed with this technique
What is cover with gauze