PowerPoint Presentation

[Audio] Welcome to the Neonatal Central Line Bundle module. Please ensure you have the necessary speakers or earphones, as this module includes audio components..

[Audio] Upon completing this course, learners should be able to define central line bundle and List the all the components, Identify the indications for central venous access, Recognize the different types of central lines, Explain the principle of stopping the line, Discuss the escalation process to address central line complications, and Describe the process of central line documentation..

[Audio] The Neonatal Central Line Bundle is a set of standardized practices designed to enhance the safety and care of neonates with central lines. Central lines are often used to give patients IV fluids, medications, and parenteral nutrition, so it is essential to understand the evidence-based interventions for central line insertion and maintenance to avoid central line associated blood stream infection. To prevent the risk of serious infections, let's take a look at what a central line bundle involves...

[Audio] The Neonatal Central Line Bundle consists of five components that work together to reduce the risk of infections in newborns receiving critical care. These components are hand hygiene, maximal barrier precautions, skin antisepsis, optimal site selection and daily review of line necessity. By following these components, we can ensure the safety of neonates and minimize the risk of infections...

[Audio] Central venous access is indicated in various medical situations, such as administration of fluids and parenteral nutrition, facilitate long-term antibiotic therapy, obtaining accurate hemodynamic measurements, frequent blood sampling, blood transfusion and when there is difficulty obtaining peripheral intravenous line. A central line is often indicated during emergency situations as it allows for rapid administration of fluids, and medications..

[Audio] There are three main types of central lines used in the NICU are the Umbilical Arterial Line, Umbilical Venous Line, and the Peripherally Inserted Central Catheter. UAC provides access to the umbilical arteries used to draw blood or to monitor blood pressure while UVC provides access to the umbilical vein used to deliver nutrition, fluids, medications, and blood transfusions, PICC provide access to large veins in the infant's arms or legs that are used to deliver nutrition, fluids, and medications..

[Audio] The central line insertion bundles typically include establishing a central line cart, performing strict hand hygiene, and the use maximal barrier precaution such as sterile gown, sterile gloves, surgical mask, hat, and sterile drapes to minimize the chances of infections or other complications..

[Audio] Other central line insertion bundles includes the proper skin preparation with cleaning agents such as Povidone Iodine, Chlorhexidine 2%, and Isopropyl Alcohol 70%. Further, we must also use a sterile transparent and permeable dressing or sterile gauze to cover the insertion site, to prevent accidental dislodgement or migration of central line..

[Audio] The central line maintenance bundles includes a combination of strict hand hygiene, evaluating the catheter and dressing site, and documentation of insertion site and dressing status. Hand hygiene is incredibly important and should be performed before and after catheter access is required. Additionally, the catheter and dressing site should be evaluated at a minimum of hourly. Lastly, the insertion site and dressing status should be documented in EPIC on an hourly basis...

[Audio] The Neonatal Central Line Bundle is an important part of optimal patient care. Reinforcing the PICC line dressing should be done if it is damp, visibly soiled, or loose. We must then wait until the PICC nurse is available to change the dressing. Adhere to your unit protocol when changing intravenous tubing and scrubbing the hubs for optimal patient care..

[Audio] The maintenance bundle also includes a daily multi-disciplinary review of catheter necessity to ensure the central lines timely removal. Follow-up x-rays should be performed per unit protocol to confirm catheter's tip position continues to be central. 48-72 hours after insertion for Ben Taub or daily for three consecutive dates after insertion for LBJ.

[Audio] When administering medication through a central line, it involves adhering to the Eight Rights of Medication Administration, procuring the necessary supplies, and performing proper hand hygiene. Furthermore, the medication hub must be scrubbed with Chlorhexidine swab making sure to use a twisting and friction motion. It is essential to take all these steps to guarantee the safety of the patient...

[Audio] After scrubbing the hub, allow the port to completely air dry. Remember to use new syringe of flush after administering medication. Medication tubing must be changed every 24 hours and labels must be attached..

[Audio] In NICU, proper PICC line dressing is crucial for maintaining asepsis and preventing complications. A good PICC dressing adheres snugly to the skin, covering the insertion site completely while a loose dressing is identified with edges of the dressing that are visibly lifted, compromising the seal and could expose the insertion site..

[Audio] Complications for central lines can occur and it is important to follow nursing interventions and escalation. If phlebitis occurs, notify the MD. If occlusion occurs, notify the charge nurse and MD to order the appropriate declotting medications. If it is a PICC line, notify the PICC nurse as well. If you identify a PICC dressing that is damp, loose or soiled, reinforce the dressing to ensure the catheter remains in place and notify the PICC nurse. If no PICC nurse is available, notify the charge nurse. If you identify any signs of infection such as redness, swelling, tenderness, etc notify the charge nurse and MD. If the catheter becomes damaged, leaking, or dislodged notify MD and charge nurse. Document all findings, escalation process and any interventions performed in the patient's medical record..

[Audio] Documenting the status of central line placement in EPIC is crucial for accurate patient records. Scheduled Insertion refers to the planned and intentional placement of central venous catheter at a predetermined time as part of medical procedure like during admission. Emergent Insertion refers to immediate placement of a central line in response to acute need such as administering life-saving medication or fluids in emergency situations..

[Audio] Ensure comprehensive documentation under LDA properties in EPIC for central line insertion, covering details such as Placement Date and Time, Line Insertion Status, Hand Hygiene adherence, Time Out Protocol compliance, Sterile Barrier utilization, proper Skin Prep and drying, Sterile Fields maintenance by all personnel, central line location, Catheter Size, inserter's identity and role in the neonatal team. Include details on insertion attempts, securement type, Insertion Depth, application of sterile connectors to all ports, and identification of personnel clearing the central line for use..

[Audio] Stop the line is a proactive strategy in healthcare that places patient safety as the top priority. All workforce members are empowered to stop the line if non-compliance with a RED RULE or central line bundle is observed. Stopping the line means that the concern must be fully addressed before proceeding with any healthcare procedures. If any safety concern persist, the workforce member is obligated to escalate the issue to leadership.

[Audio] As part of CLABSI prevention, routine audits are done including LDA documentation, dressing, tubing, and site assessment. The purpose of this audit is to detect variances in practice as measured against best practice standard for CLABSI prevention.

REFERENCES. The Joint Commission. Preventing Central Line—Associated Bloodstream Infections: Useful Tools, An International Perspective Nov 20, 2013. Accessed [8/3/15]. http : / (www.j ointcommission.org/CLABSIToolki. "Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline After Bundles and Checklists." American Academy of Pediatrics, 10 Dec. 2010. Web. 3 Aug. http:((pediatrics.aappublications.org/content(127/3/436.full.pdf. 2015. "Umbilical Catheter Blood Specimen Collection." Umbilical Catheter Blood Specimen Collection. 1 May 2012. Web. 18 Aug. 2015. <http://www.slideshare.net/wcmc/umbilical- catheter-blood-specimen-collection>. "Medworxx Intranet." Medworxx Intranet. BC Women's Hospital and Health Centre, 18 Féb.GGSÄ&eb. 18 Aug. 2015. bccwhcms.medworxx.com Site Published bcw document render.a x?docum entRender.IdType=29&documentRender.GenericField=1&documentRender.I Walsh, K. "Blood Sampling through a Central Venous Access Device (Closed System): Pediatric Patient." Nursinq Reference Center. EBSCO Host, 24 Dec. 2014. Web. 19 Aug. <http:Ldweb.a.ebscohost.com/nrc/pdf?sid=52411fac-frfd-4dfe-9899- 2015• C. "Umbilical Catheter Placement and Care: Performing." Nursing Reference Center. EBSCOhost, 13 Sept. 2013. Web. 20 Aug. 2015. <http:(/T3ÄGÜohost.com/nrc.