Jan Bazner-Chandler RN, MSN, CNS, CPNP IV Management Jan Bazner-Chandler RN, MSN, CNS, CPNP

Central Venous Catheter

Central Line Bundle Hand Hygiene Maximal barrier precautions upon insertion Chlorhexidine skin antisepsis Optimal catheter site selection; subclavian vein is the preferred site for non-tunneled catheter Daily review of line necessity with prompt removal of unnecessary lines

CA-BSI Central venous catheter-associated blood stream infection Three criteria for diagnosis

Criterion I A recognized pathogen in the blood found from one or more blood cultures, and the pathogen is not related to an infection at another site.

Criterion 2 Patient has at least one of the following signs or symptoms: fever (over 100.4 F or 38 C, chills, hypotension and Positive laboratory results not related to infection at another site Common skin contaminant identified in two separate cultures taken within 48 hours of each other.

Criterion 3 A patient less than one year old has at least one of the following signs or symptoms: fever (over 100.4 F or 38 C) or hypothermia (under 98.6 F 37 C) apnea, or bradycardia and Positive laboratory results not related to an infection at another site Common skin contaminant found in two blood draws – within 48 hours

Risk Factors Three lumen catheters TPN running through central line Inexperienced physician inserting line Low patient – nurse ratio Long – term catheter Special care units

Total Parental Nutrition A tunneled catheter should have An occlusive dressing in place. Whaley & Wong

TPN Therapy TPN 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.

TPN: 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.

Complications of TPN Sepsis: infection Liver dysfunction Respiratory distress from too –rapid infusion of fluids