AUDIT OF CENTRAL VENOUS CATHETER CARE AND MAINTENANCE IN A CARDIAC SURGERY UNIT

Objective

To audit central venous catheter care in our current practice based upon the current guidelines.

Design and method

The data was collected over a period of 15 days during the month of July 2023. All the patients in ITU were assessed at random times and the data regarding care and maintenance of central lines was noted. Bed side nursing staff was kept blind regarding the ongoing audit.

Results and conclusions

1. Total number of patients analysed N= 176

2. Number of central lines N= 229

3. Total number of lumens N= 799

4. Total number of lumens in use 63.95% (511/799)

5. 3-way tap turned OFF to patient (Y/N) 3.7% (130/5)

6. Blue clips applied when not in use (Y/N) 5.2% (128/7)

7. Caps missing for the 3 way taps (Y/N) 2.8% (5/171)

8. Integrity of central line dressing (Y/N) 10.8% (157/19)

9. Air in infusion bags 0 %

10. Air-eliminating filter on infusion tubing sets No

11. Air in line sensor in infusion pump No

12. Any tubing misconnections No

13. Any break in the closed system No

Conclusion

• The risk of venous air embolism can be reduced by regular education and training of staff, keeping up to date with the current guidelines and re-auditing regularly.

Recommendations

1. During insertion

• All lumens should be flushed and Luer–lock connections with self-sealing valves should be applied.

• CVP can be raised (to decrease the pressure gradient) by placing the patient in Trendelenburg position. The use of ultrasound can help to assess the degree of hydration and the need for Trendelenburg position.

• When no guide wire in place, the needle hub should be occluded with thumb.

• Line should be properly secured to the skin as accidental removal or partial removal can lead to air embolism.

2. Maintenance and care

• All connections should be tight, and all unused hubs are closed and locked when not in use.

• Regular inspection of the catheter for connections, cracks, or broken seals.

• Syringes should be fully primed and de-aired.

• Syringes should be kept vertical above the IV connector and not emptied completely.

• Infusion pumps should have air-in-line sensors for all continuous infusions.

• Fluid warmers, high volume resuscitation devices and extra-corporeal circuits should have bubble removal /warning systems.

• Special care during patient transfer or movement as accidental pulling of the catheter can lead to breakage or exposure of proximal orifice of multi-lumen catheter.

3. Removal

• The insertion site should be below the level of the heart at the time of removal.

• CVP can be raised during removal by keeping the patient in a head down or Trendelenburg position.

• Patients can perform Valsalva manoeuvre during removal, if possible. Otherwise remove the catheter during active expiration.

• The exit site should be covered with air-occlusive impermeable dressing for at least 24 hrs.

• Patient to remains supine for at least 60 min after central venous access removal.

• Establishment of a catheter removal protocol/checklist along with regular training.