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For Nurses and Allied Staff

Care and Maintenance of Central Venous Catheters 2.0


Description
This course is designed to teach healthcare workers how to properly assess, access, maintain, and remove central venous catheters (CVCs). This course also includes a section containing important information for nurses and others who are assistants during the insertion of these lines. Nurses and other allied staff involved in the care of CVCs are encouraged to complete this course. There is a separate course available from Duke Infection Control Outreach Network (DICON) for physicians who are involved in the insertion of CVCs. See main course listing.

The course consists of text, slides and video clips, post-test and evaluation form. The course has been updated to include MANDATORY and OPTIONAL sections. You will only have to complete the mandatory sections prior to taking the quiz to receive CEU credits. The course will take approximately 50 to 60 minutes to complete. You may complete your educational experience in one sitting or save your session and return to where you left off.
Release Date: 11/01/2015; Latest Review Date: 7/08/2020; Expiration Date: 7/08/2022;

Rationale
Modern medicine has become progressively more complex. Examples of this complexity include the technical aspects of insertion, care and maintenance, and removal of central venous catheters. These catheters are frequently used to deliver an array of intravenous medicines and fluids. However such devices have risks. Use of short-term and long term vascular catheters is associated with important and serious risks of mechanical and infective complications. Catheter-related bloodstream infections (CR-BSIs) can cause substantial morbidity and mortality and many such infections are preventable if meticulous care is used during insertion and maintenance of these CVCs.

Prevention of vascular catheter-associated adverse events has become a cornerstone of patient safety programs at most American hospitals. Nurses and other healthcare workers have an important role in reducing the risk of adverse events due to CVCs.

The “100k Lives” and “5 Million Lives” campaigns, initiated by the Institute of Healthcare Improvement (IHI), emphasized the use of five simple and practical interventions during the insertion of CVCs in order to reduce the risk of catheter-related bloodstream infections (CR- BSIs). These five recommendations are the basis for what is now known as the “central line bundle”. These five practices should be used during and after the insertion of all central vascular catheters. The risk of developing a CR-BSIs can be decreased dramatically by utilizing a multi-faceted team approach to implementing the components of this CVC bundle (Pronovost, Needham et al. 2006 (http://www.ncbi.nlm.nih.gov/pubmed/17192537)).

The “CVC bundle” consists of:
  • Strict use of hand hygiene prior to catheter insertion.
  • Maximal barrier precautions during catheter insertion.
  • Chlorhexidine skin antisepsis prior to catheter insertion.
  • Selection of the most appropriate site for catheter insertion.
  • Daily assessment after insertion to determine the need for continuing catheter use.
This course incorporates elements of the CVC bundle and trains healthcare staff about appropriate techniques for assessment, access, maintenance and removal of CVCs. Information in this course will allow you to help decrease the risk of catheter-related adverse events in your patients and improve their care.

Instructions for Completion
Complete all sections of the on-line course in sequence in order to successfully complete the course and receive credit for completion. Learners must demonstrate performance by achieving a minimum of 80% on the post-test. In addition, to be credited with completion, submit the evaluation form which follows the post-test. You may then print a certificate of completion for your records.

Statement of Joint Accreditation
In support of improving patient care, Duke University Health System Clinical Education & Professional Development is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

Nurse CE: Duke University Health System Department of Clinical Education and Professional Development designates this activity for up to 1 credit hour for nurses. Nurses should claim only credit commensurate with the extent of their participation in this activity

Category 1 credit for physicians is NOT provided for this course.
Content
  • Instructions and Objectives
  • I. Central Venous Catheters - Introduction
  • I.1 Central Venous Catheters -Introduction
  • I.2 Infectious Complications Related to CVCs
  • I.3 Aims and Structure of this CVC course
  • II. Role of the Assistant During the CVC Insertion Process
  • II.1 Role of the Assistant During the CVC Insertion Process - Introduction
  • II.2 Assemble required equipment
  • II.3 Informed Consent
  • II.4 Sample Consent Form
  • II.5 Prepare the Patient Room
  • II.6 Perform “Time out” procedure to verify the identity of the patient
  • II.7 The CVC bundle
  • II.8 CVC bundle item #1: Hand Hygiene and Personal Protection Equipment
  • II.9 CVC bundle item #2: Chlorhexidine Skin Antisepsis
  • II.10 CVC bundle item #3: Maximal Barrier Protection
  • II.11 CVC bundle item #4: Select the appropriate site for catheter insertion
  • II.12 CVC bundle item #5: Assess indication for CVC
  • II.13 Complete a safety checklist
  • II.14 Sample Checklist
  • II.15 Do not allow the procedure to proceed or continue if
  • II.16 CVC Insertion Procedure
  • II.17 Reassuring and supporting the patient
  • II.18 Assistance during the CVC Procedure
  • II.19 Summary of the process in placing a CVC
  • III. Role of the Assistant During Ultrasound Guided Insertion of CVCs
  • III.1 Role of the Assistant During Ultrasound Guided Insertion of CVCs
  • III.2 Operating the ultrasound machine
  • IV. Role of the Assistant After the Insertion of the CVC
  • IV.1 Role of the Assistant After the Insertion of the CVC - Introduction
  • IV.2 Securing the CVC
  • IV.3 Which dressing should be used after securing the CVC?
  • IV.4 Disposing of used supplies and hand hygiene
  • IV.5 Check the position of the catheter with a chest X-ray
  • IV.6 Monitoring of the patient
  • IV.7 Monitoring of the patient (Continued)
  • IV.8 Documentation of the procedure & assessment of the patient
  • V. Guidelines for Care and Maintenance of the CVC
  • V.1 Guidelines for Care and Maintenance of the CVC - Introduction
  • V.2 How often should IV tubing be changed?
  • V.3 What is the recommended technique for changing IV sets attached to the CVC?
  • V.4 Dressing changes to the CVC site
  • V.5 Method for changing CVC dressing
  • V.6 Frequency of changing CVC dressing
  • V.7 Daily inspection of CVC dressings
  • VI. Techniques for Safely Accessing a CVC
  • VI.1 Techniques for Safely Accessing a CVC - Introduction
  • VI.2 Hand Hygiene
  • VI.3 Maintenance of closed infusion system
  • VI.4 Recommended Techniques for Accessing a CVC
  • VII. Recognition and Management of Common Catheter Complications
  • VII.1 Recognition and Management of Common Catheter Complications - Introduction
  • VII.2 Central vascular catheter is not properly functioning
  • VII.3 Bedside methods to manage poorly functioning CVCs
  • VII.4 Infection-related complications of the CVC
  • VII.5 Exit-site infection
  • VII.6 Infection of the catheter tract
  • VII.7 Central-line associated bloodstream infection (CLABSI)
  • VIII. Indications and Techniques for Removal of CVCs Introduction
  • VIII.1 Indications and Techniques for Removal of CVCs - Introduction
  • VIII.2 Clinical indications to remove a central line catheter
  • VIII.3 Technique for CVC removal
  • IX. Advanced Topics in Management of CVC Complications
  • IX.1 Dealing with CVC thrombosis
  • IX.2 References for Care and Maintenance of CVCs
  • Assesment
  • Quiz: Care and Maintenance of Central Venous Catheters 2.0
  • Post-Course Survey: Care and Maintenance of Central Venous Catheters
Completion rules
  • All units must be completed
  • Leads to a certification with a duration: Forever