BACKGROUND
As the setting change in which
patient care is provided, so do
the risks and complexities
associated with care.
Patients with central venous
catheters (CVCs), particularly
those for whom long-term
vascular access is needed, are
seen increasingly in the
inpatient, outpatient, and
home care setting.
The process of inserting these
catheters disrupts skin integrity
and increases the risk of
bacterial infection. These
infections may result in serious
harm to the patient, including
death.
It has been estimated that
CVCs are associated with
almost 90% of all bloodstream
infections. Strict adherence to
guidelines has demonstrated
that these infections are
largely preventable.
COST
Central line-associated
bloodstream infections
(CA-BSI) prolong
hospitalization by
approximately 7 days and
have an estimated attributable
cost of between $3,700 and
$29,000.
MORTALITY
Approximately 50% of patients
in an Intensive Care Unit have
a CVC accounting for about
15 million catheter days each
year.
It has been estimated that
there are approximately
250,000 CA-BSIs each year
and studies have suggested
that mortality attributable to
these infections is between 4%
and 20% resulting in an
estimated 500 to 4,000 patient
deaths each year in the U.S.
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The central line bundle consists
of five key components:
Hand Hygiene
Alcohol-based hand rubs have been
shown to reduce HAIs and should be
used before, during and after central
line placement as follows:
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 | | Before and after palpating | | | the catheter insertion site
during site assessment
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| | Before and after inserting, | | | replacing, accessing,
repairing, or dressing an
intravascular catheter
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| | Between patients | | | |
| | Hand Hygiene
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| | Maximum barrier precautions
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| | Optimal catheter site selection | | | with the subclavian vein as the
preferred site for on-tunnelled
catheter
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| | Daily review of line necessity | | | with prompt removal of
unnecessary lines.
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