Check list and CVC Dr ROSAY Unité d accès vasculaire DAR CLB Lyon

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1 Check list and CVC 2015 Dr ROSAY Unité d accès vasculaire DAR CLB Lyon

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7 Provonost P Berenholtz SM

8 To err is human

9 Preven6on of Catheters Related Bloodstream Infec6ons Berenholtz SM, Crit Care Med, 2004

10 Compliance with the bundle

11 Preven6on of Catheters Related Bloodstream Infec6ons STAGE 5 : Stop interven6on by the nurses in 32% of cases Berenholtz SM, Crit Care Med, 2004

12 Preven6on of Catheters Related Bloodstream Infec6ons SICU 11.3 Educa6on CVC trolley 16 months later Check-list Interven6on 0.5 CSICU 0

13 Preven6on of Catheters Related Bloodstream Infec6ons 103 ICU, Team leaders (Physician + Nurse), educa6on «bundle» : Wash hands immediatly prior, Sterilize procedure site with chlorhexidine Surgical dressing during the process Avoid femoral loca6on Revove unnecessary catheters Pronovost et al, NEJM 2006

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15 Preven6on of Catheters Related Bloodstream Infec6ons 25ème P Médiane 75ème P Risk reduction: 66% Baseline Pendant 0-3 m 4-6 m. 7-9 m m m m lives saved 75 Millions $ saved Pronovost et al, NEJM 2007

16 Main benefits of Check lists: Help to memory recall Make explicit the minimum expected steps in complex processes Check lists established a higher standart of baseline performance, the best compliance to bundle

17 If something so easy can transform intensive care, Why not would we do it for all CVC?

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20 These check list is targe6ng 5 fundamental points Before the act During the act AHer the act 1-EsKmate the risks 2-Compliance with hygiene procedures 4-Post operakve control of Catheter Kp locakon and absence of complicakons 3-Per operakve verificakon of the catheter funckonality 5-Traceability

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22 Instruc6ons before the act Iden6ty Consent Risk assessment: bleeding, allergic, Anatomical CI, Pathology... Equipment inser6on site according to the condi6on, the dura6on es6mated useful context... Choice of equipment according to the indica6on Skin prepara6on: shearing if necessary, at least a shower (including shampoo) with soap; toilet on the bed closer to placement. Monitoring. Checking the Equipment Ultrasounds: probe covers and sterile gels

23 Instruc6ons: during the act Hygiene procedures Fric6on, cleaning, disinfec6ng with alcohol an6sep6c Terms of surgical asepsis surgical dressing Implementa6on of sterile drapes covering the field: maximum barrier Checking during opera6on Mechanical Posi6onal Func6onal If deferred use: close the CVC / VD with a lock fluid injected through a valve bidirec6onal screw (Luer lock). Protec6on with occlusive sterile dressing.

24 Instruc6ons: ader the placement Verifica6on distal end of the catheter: imagery? Traceability / Repor6ng: date, pa6ent iden6ty and operator, type of material and batch number, Laying condi6ons, inser6on site, number of punctures and possible complica6ons Datas kept in the medical file pa6ent Pa6ent informa6on CVC / DV: info booklet: type VD, basic rules. Phones and Contacts in case of emergency

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28 Checklist CVC Checklist approved by the College HAS, January 27, 2011 and on-line the site to be available to professionals who wish to use it. This checklist is not obligatory in the cer6fica6on of hospital, like "Pa6ent safety block opera6ve "whom prac6ce is obligatory and a Priority, since 1 January 2010

29 French Check list Evalua6on Physician s feelings about this list: It is useful It is good for young it is useful for teaching It does not protect us in case of claims it makes us loss our 6me it verifies the cri6cal points it avoids oversights, errors Ø It improve security

30 Limits of french check list lille frequent use no results available except some rare ICU specially rare in long-term infec6ons TPN, dialysis, oncology Not evidence of it effec6veness ; No epidemiology Not obligatory

31 Do not put the cart before the horse We need assessment

32 For all your projects, if you want some results: Behave like a duck Above the water, look calm and collected Under the water, paddle like mad