3Central Line Bundle Hand Hygiene Maximal barrier precautions upon insertionChlorhexidine skin antisepsisOptimal catheter site selection; subclavian vein is the preferred site for non-tunneled catheterDaily review of line necessity with prompt removal of unnecessary lines
4CA-BSI Central venous catheter-associated blood stream infection Three criteria for diagnosis
5Criterion IA recognized pathogen in the blood found from one or more blood cultures, and the pathogen is not related to an infection at another site.
6Criterion 2Patient has at least one of the following signs or symptoms: fever (over F or 38 C, chills, hypotension andPositive laboratory results not related to infection at another siteCommon skin contaminant identified in two separate cultures taken within 48 hours of each other.
7Criterion 3A patient less than one year old has at least one of the following signs or symptoms: fever (over F or 38 C) or hypothermia (under 98.6 F 37 C) apnea, or bradycardia andPositive laboratory results not related to an infection at another siteCommon skin contaminant found in two blood draws – within 48 hours
8Risk Factors Three lumen catheters TPN running through central line Inexperienced physician inserting lineLow patient – nurse ratioLong – term catheterSpecial care units
9Total Parental Nutrition A tunneled catheter should haveAn occlusive dressing in place.Whaley & Wong
10TPN TherapyTPN provides complete nutrition for children who cannot consume sufficient nutrients through gastrointestinal tact to meet and sustain metabolic requirements.TPN solutions provide protein, carbohydrates, electrolytes, vitamins, minerals, trace elements and fats.
11TPN: care reminder caREminder: The TPN infusion rate should remain fairly constant to avoid glucose overload. The infusion rate should never be abruptly increased or decreased.Bag and tubing need to be changed every 24 hours.
12Complications of TPN Sepsis: infection Liver dysfunction Respiratory distress from too –rapid infusion of fluids