Central Vascular Catheter Insertion Checklist Standard Operating Procedure Perform optimal care Improving process to improve outcome This checklist is adapted with kind permission from the checklist devised at Johns Hopkins Hospitals
The example of a Standard Operating Procedure overleaf illustrates one way to deploy the CVC insertion checklist. You can use it as somewhere to start, but it is anticipated that locally the checklist will be used in many different ways, for example, local decisions include: who does it, and how the data are collected/monitored. Some items on the checklist may be locally redundant and could be removed. Successful implementation of this checklist can be achieved using the SPSP rapid cycle testing methodology. Please use this procedure as a starting point but do not consider it to be prescriptive. How you reliably put this checklist into use is up to you and your team locally. Please note SICSAG have also produced an insertion bundle. What is important is that there is a checklist, which is evidence based and that checklist reliably aids those inserting CVCs to do so correctly. The SICSAG insertion bundle can be found at the following web address: http://www.sicsag.scot.nhs.uk/subgroup/hai.html HPS would be delighted to assist in the sharing of good practice, please let us know of anything you have identified that could help someone else do it better quicker. Email: HPSinfectioncontrol@hps.scot.nhs.uk Other tools that may help you with this bundle are found at http://www.hps.scot.nhs.uk/haiic/ic/index.aspx
Example of how to use the Central Vascular Catheter (CVC) Insertion Checklist Statement CVCs are the leading cause of device-related blood stream infections [1]. Micro-organisms that gain entry during the insertion procedure can subsequently cause infection of the line [2-4]. It has been shown that use of Checklists can significantly improve the chances of getting the procedure right every time [5]. Objectives 1. To ensure the Central Vascular Catheter insertion procedure in OUR hospital/ward/ unit/theatre is optimal, evidence-based and minimises the risk of harm to the patient. 2. To be able to demonstrate quality CVC care in OUR hospital/unit/ward/theatre. Requirements Knowledge of where all central lines are inserted within the hospital. Agreement with those in charge of all the clinical units that insertion checklists will be used every time a CVC is inserted. A mechanism for knowing when a line has been inserted. HCWs committed to patient safety. The correct procedure clearly displayed within every unit where CVC insertion takes place. In addition to the collection of sundries and equipment for the procedure, a nominated observer trained to use the checklist and knowledgeable on how the procedure should be done. Procedure 1. Every time a CVC is to be inserted the person who will insert the CVC should nominate an observer to complete the checklist. 2. The observer will observe the procedure and record observations on the checklist. (The observer may also be assisting the operator during the procedure and complete the checklist at the end of the procedure). After care Complete form. Give it to: Discuss and display the data when it has been returned.
Date: Time : (24hr clock) Location: ITU SHDU MHDU A&E Theatres Other state: Planned Procedure Yes No Guidewire exchange (not recommended) Yes No Emergency Procedure Yes No I confirm that I have completed an approved CVC education package and that I have been signed off as being competent. I have not completed the above package but consider myself to be competent in CVC insertion. (Perform under supervision if operator has inserted <3 CVCs). The Procedure Yes tick this box or the box below Yes The operator (and supervisor) performed a Surgical Scrub Yes No The operator (and supervisor) wore hat, mask, sterile gown and sterile gloves Yes No Chlorexidine 2% in alcohol was applied to the insertion site and allowed to dry before Yes No the procedure was progressed. Sterile drapes were placed to create a sterile operating field. Yes No Number of skin punctures: 1 2 3 4 Number of needle passes: 1 2 3 4 (Seek the help of a supervisor if more than 3 unsuccessful insertions) Type of Catheter Insertion site Side inserted CVC IJV Right Introducer Subclavian Left Vascath Femoral (If possible avoid using the femoral site) Other: A sterile field was maintained throughout the procedure Yes No Ultrasound was performed. Yes No Ultrasound was performed in real-time Yes No Clean blood from the site using chlorhexidene 2% in alcohol and dry site Yes No The CVC was secured with: A sterile CVC dressing was placed over the insertion site. (The dressing must be Yes specifically designed for vascular catheter insertion site protection). Name of Operator: Name of supervisor (if applicable) Name of Observer: Local process notes: No
References: 1. Coello, R., et al., Device-related sources of bacteraemia in English hospitals-- opportunities for the prevention of hospital-acquired bacteraemia. J Hosp Infect, 2003. 53(1): p. 46-57. 2. Pratt, R.J., et al., epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect, 2007. 65 Suppl 1: p. S1-64. 3. Pascual, A., Pathogenesis of catheter-related infections: lessons for new designs. Clin Microbiol Infect, 2002. 8(5): p. 256-64. 4. O'Grady, N.P., et al., Guidelines for the prevention of intravascular catheterrelated infections. Centers for Disease Control and Prevention. MMWR Recomm Rep, 2002. 51(RR-10): p. 1-29. 5. Berenholtz, S.M., et al., Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med, 2004. 32(10): p. 2014-20.