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Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
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A focus on central lines —preventing hospital-acquired infections

The Centers for Disease Control estimate that 41,000 bloodstream infections occur in U.S. hospitals each year, with a large proportion associated with a central vascular catheter. Bloodstream infections typically result in a prolonged hospital stay, increased costs for both the patient and hospital, and an increased risk of mortality. Central Line-Associated Bloodstream Infections (CLABSIs) can be prevented through proper management of the central line.  For further information on CLABSI prevention, visit the CDC’s website at: http://www.cdc.gov/HAI/bsi/bsi.html#tools

BIOPATCH®

Use of BIOPATCH® for central line dressings at MGH
BIOPATCH® is a chlorhexidine (CHG) impregnated sponge dressing that is placed at the insertion site of central venous catheters.  It provides continual antisepsis over 7 days, thus preventing skin organisms from entering at the insertion site and tracking extraluminally up the catheter and into the bloodstream.  Although BIOPATCH® has been used for PICC line care for quite some time at MGH, its use was extended to all central line catheters in the latter part of 2013, including implanted ports accessed for more than 24 hours.

Biopatch FAQ click here

FAQ Sheet:  BIOPATCH® use with Implanted Ports in Ambulatory Settings
click here

Additional BIOPATCH® resources 

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MGH NARRATIVES

"Every week I administered chemotherapy to Sue, one of my breast cancer patients. Prior to starting chemo treatment, Sue had a lumpectomy and lymph nodes removed from under her left arm. As an oncology nurse I know it is best to avoid using the affected arm for intravenous insertions because of significant risk of lymphedema. As part of Sue’s treatment, she was scheduled for weekly Taxol and Herceptin infusions. To safely administer these medications..."
read more...

Read other MGH narratives about managing central lines:
Stefanie Walsh, RN, OCN | Heather D. Kuberski RN, BSN, OCN

CENTRAL LINE TOOL KIT

catheterport photohickman photo

A Visual Guide to Central Lines click here


Videos

Pulsatile (Push/Pause) Flushing Technique Video click here

Central line dressing change without BIOPATCH click here

Patient Education: Home Disconnect Program- Disconnecting your home infusion & deaccessing your port
Certain chemotherapy regimens may require that patients go home with continuous chemotherapy infusing through home infusion pumps.  In some cases, patients may have the option for disconnecting their medication at home. This instructional video will reinforce the teaching provided to the patient by their nurse in the Mass General Cancer Center
click here


Central Line Insertion

Policy & Procedures

Central Venous Catheter Insertion and Guidewire Exchange click here

Infection Prevention Policy for Central Venous And Pulmonary Artery Catheter Insertion click here

Central Line Placement Checklist click here

Central Line Checklist Nursing Tips click here


Teaching Modules

Nursing Management of Venous Access Devices (VADs):
View Module List

 

 


Types of Central Venous
Catheters

Algorithm for Determining Essential and Non-Essential Central Venous Catheters click here


 

Implanted Ports (Visual Guide)

Policy & Procedure: Identification and Access of Implantable Venous Access Ports (IVAPS)

Implanted Central Venous Access Devices (Ports) Teaching Module

Bulletin: Bard Implanted Ports & Palpation Points (internal access only)

Timing of port placements for patients receiving Bevacizumab (Avastin) therapy

Guidelines for blood draws from implanted ports

Patient Education: Home Disconnect Program- Disconnecting your home infusion & deaccessing your port
Certain chemotherapy regimens may require that patients go home with continuous chemotherapy infusing through home infusion pumps.  In some cases, patients may have the option for disconnecting their medication at home. This instructional video will reinforce the teaching provided to the patient by their nurse in the Mass General Cancer Center
click here


PICCs (Visual Guide)

PICC wristband

 

 

NEW: Pink PICC line wrist bands

The new PICC wrist bands will have limited information on
them: the type of catheter, length and number of lumens. 
The IV Team hopes that the pink bracelets will be a better identifier of patients with PICC lines and help to prevent blood pressures and blood draws from being done on that extremity.

PICC line dressing change with BIOPATCH® click here

PICC line dressing change with BIOSEAL CVC  click here        

PICC line Removal & Competency click here

StatLock PICC Plus securement device click here

Peripherally Inserted Central Catheter (PICC) Care & Maintenance - Guidelines for PICC lines click here

PICC Insertion via Ultrasound Guidance, Sherlock Tip Positioning System and 3CG Tip Confirmation System: Click here             

“Go With the Flow” PICC Line Flushing Tips click here

PICC Teaching module click here

PICC Line Occlusion Data click here (internal access only)

PICC Documentation
PICC insertions are now documented electronically in Epic. This allows immediate availability of information to all patient care providers.


Non-tunneled Central Venous Catheters
(Visual Guide)

Overview click here

Removal click here

Non-tunneled central catheter teaching module click here


Subcutaneous Tunneled Central
Venous Catheters
(Visual Guide)

Overview click here

Tunneled Central Catheter Teaching Module click here


Pheresis and Hemodialysis Catheters (Visual Guide)

Teaching module click here


 

Troubleshooting Central Lines

Trouble-shooting Guide for Central Lines click here

Complications and Troubleshooting Teaching Module click here


Central Line Care

Dressing Change

Policy & Procedure

BIOPATCH® click here

Video: Central line dressing change without BIOPATCH
click here


Flushing

Policy & Procedure

Video

  • Pulsatile (Push/Pause) Flushing Technique Video
    click here

Needleless Connector Change

Blood Draws

KEY CONTACTS

IV Therapy

Radiology

Bone Marrow Transplant

Policy, Procedure & Products Committee

Meets: 2nd Tuesday monthly, 1-3pm
Sweet Conference Room Gray/Bigelow 432

Link to Champions and Chairs click here

http://www.mghpcs.org/IPC/Programs/Committees/policy.asp

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INFECTION CONTROL

In her new role as Project Manager, Paula Wright, RN, is responsible for coordinating CLABSI prevention efforts, including
the Biopatch roll out and introduction of the use of an alcohol cap.  Her efforts have built upon work initiated in 2009, when a multidisciplinary team rolled out a central line-associated bloodstream infection prevention initiative. The goal was to develop a standard approach throughout MGH that adheres to evidence based practices. All of their work has led to several significant changes, including:

  • Developing a standardized central line insertion kit
  • Creating a central line insertion checklist and monitor to ensure all steps for safe line placement were being taken
  • Introducing chlorhexidine for skin prep
  • Introducing use of the BIOPATCH® for all central line dressings
  • Using maximal sterile barriers
  • Establishing a formalized feedback mechanism for all central line-associated bloodstream infections (CLABSI) diagnosed in ICU patients: upon diagnosis of a CLABSI on the unit, Infection Control informs unit leadership, who then perform an investigation to identify root causes and opportunities for learning
  • Using color coded stickers to identify a line that was placed in strict adherence to infection control policies, versus those placed in less than ideal conditions (e.g., emergent situations)
  • Systematically evaluating new products to reduce CLABSIs (e.g.  BIOPATCH® alcohol caps)

CLABSI Quality Improvement Resources

Infection Prevention Policy for Central Venous and Pulmonary Artery Catheter Insertion


CLABSI QUALITY IMPROVEMENT RESOURCES

THE DATA

Infection Control
MGH tracks Central Line-Associated Bloodstream Infection (CLABSI) rates in most of the ICU areas, and since April 2011, in the general care areas. MGH rates are compared to national benchmarks that are published by the Centers for Disease Control’s National Healthcare Safety Network (NSHN). Below are the most recent quarterly MGH ICU rates.

CLABSI click here (internal access only)

PICC Line Occlusion Data click here (internal access only)

Did You Know?

At MGH, an estimated $48,000 is spent monthly on 2mg/2ml tissue plasminogen activator (tPA), otherwise known as “alteplase.”

PATIENT EDUCATION

Implanted Ports: What You Need to Know click here

Preventing Central Line Bloodstream Infections click here

Managing Your Non-Tunneled (Percutaneous) Catheter click here

Patient Education: Home Disconnect Program- Disconnecting your home infusion & deaccessing your port
Certain chemotherapy regimens may require that patients go home with continuous chemotherapy infusing through home infusion pumps.  In some cases, patients may have the option for disconnecting their medication at home. This instructional video will reinforce the teaching provided to the patient by their nurse in the Mass General Cancer Center
click here

SPOTLIGHT ON PRACTICE

MGH Interventional Radiology’s Advanced Practitioners

Since early 2000, the Interventional Radiology (IR) department at MGH began utilizing advanced practitioners to assist with a variety of procedures, including placement of implanted ports.  Since then, these trailblazers have become integral to the success of the ever-growing IR department.   Not only are they great resources for staff, they are committed to reducing CLABSI rates and improving the quality of life for all of our patients. 


Education: 1998 Masters Degree in Nursing University of Massachusetts Medical Center Graduate School; 1992 Bachelor's Degree in Nursing University of Massachusetts

Certification:  Association of Vascular Access, BLS/ACLS

Clinical Interests:  Vascular Access, Oncology Care, Quality Improvement

" I began placing ports and vascular access devices in patients at Massachusetts General Hospital in early 2000. At the time, there were no other Nurse Practitioners or Physician Assistants in Radiology. With the support of the department, I helped develop and advance the role which has now become an invaluable part of our department. Since then, I have had the continued privilege of being able to help patients receiving treatment by providing both a reliable way to receive their medications and improve their quality of life.

 


Education:  Master’s in Health Care Management Cambridge College (currently enrolled), Master’s in Science of Physician Assisting from Northeastern University 2010, Bachelors of Arts and Science Biological Anthropology Harvard University 2006.

Employment: Physician Assistant MGH Interventional Radiology 2010-2013, Founding Coordinator Harvard University Fund for Service Internship Program 2006-2007, Medical Assistant/Research Coordinator 2007-2010
Interests: Multidisciplinary care (member of FMD, HHT, IPF, HCC clinics), women’s health in IR (launched MDC IPF program with OBGYN colleagues), Care redesign and quality improvement initiatives (IVC filter quality improvement project, CPIP participant, IR E-flow sheet and patient/provider satisfaction surveys)

 

 


As the first Clinical Nurse Specialist in one of the largest Interventional Radiology Departments in the country; Penzias' role encompasses the three spheres of influence for the CNS. She has been a nurse for almost 30 years and has practiced in Canada, the US and the Middle East. She has been involved in Education for ten years with a background in Critical Care, Trauma and Emergency Nursing, and a CNS for almost 5 years. 

The complexity and variety of the procedures offered to a fragile, medically complex and at times critically ill patient population require a nursing force ready and able to provide ‘patient-centered, episodic critical care’. Penzias designed and implemented evidence-based orientation and competency programs; as well as prepared Radiology Nursing for inclusion in the successful first Magnet survey of Ambulatory Care Settings. She is a certified BLS, ACLS, PALS, ENPC and TNCC instructor; and has presented locally and nationally on a variety of topics. She is involved in the development of evidence-based protocols, policies, care guidelines and collaborates with peers within the institution, regionally and nationally. She is a founding member of the COBTH IR Nursing group, and sits on the editorial board of the Journal for Radiology Nursing

Nursing interests: time-sensitive care, Nursing Presence, Medical Simulation and the influence of education on outcomes.


Education: Received her Masters in Science of Nursing from the University of Colorado, Bethyl School of Health Sciences, Colorado Springs. Undergraduate Bachelors of Science in Nursing from the University of Massachusetts, Amherst

Certifications: vascular access certified, PICC certified, and  ACLS/BLS
Participant to raise money as participant in the Pan Mass Challenge and MGH Oncology ride for children and MS ride.

Employment: Her clinical nursing career included work in trauma/ surgical ICU, Neurosurgical ICU,CCU and cardiac catheterization lab (provided sedation),and Interventional Radiology providing sedation for adults and children.

Clinical interests: include vascular access, oncology, multidisciplinary care, women’s health, vascular anomalies and venous insufficiency.

Publication: Image-Guided percutaneous radiofrequency ablation and the incidence of post radiofrequency ablation syndrome: a prospective survey. Radiology 12/2005;237(3):1097-102


The RNs on the Lunder 10 Cancer Care Unit are piloting a yearly "Central Line Competency." The competency was developed with the input of staff. Staff RNs from the Lunder 10 Quality Committee are taking a role in the implementation of the competency.  The competency delineates the steps needed to change a central line dressing and caps. A Quality Committee member, or the CNS, will then objectively observe and evaluate another RN as she performs a central line dressing change, using the criteria in the competency. This provides a great opportunity for RNs to coach one another. This also serves as a way for the unit as a whole to maintain a uniformly sound practice. click here to view skills checklist

(Pictured left) Judith V. Curran RN, MS, AOCNS
Oncology Clinical Nurse Specialist


THE MGH Cardiac ICU has instituted several changes in an effort to address concerns commonly related to central line-associated bloodstream infections, including:
  • Inservicing staff members on a 20-second scrub of access ports of all central lines
  • Requiring the use of a Central Line Infection Prevention Checklist for the insertion of all central lines
  • Instituting the practice of changing the cap on the stopcock after every blood draw
  • Coordinating with the Cardiac Cath Lab for proper central line dressing techniques and attaching all PA cath tubing set ups to line following placement.

Central Line-Associated Bloodstream Infections in the ICU click here to view data


Patients with End Stage Renal Disease

Vein Sparing for Patients with Renal Dysfunction:
A Did You Know? poster by Mary Sylvia-Reardon, RN, DNP, nursing director, MGH Hemodialysis Unit

click here to view poster

Nursing Knowledge Survey - related to PICC Placement in Patients with Renal Dysfunction
click here to view

Guidelines for Venous Access in Patients with Chronic Kidney Disease or Renal Insufficiency
click here to view

IN THE NEWS
OTHER CENTRAL LINE RESOURCES
EXTERNAL REVIEWERS
Joint Commission logo

According to the Centers for Disease Control (CDC), each year, millions of people acquire an infection while receiving care, treatment, and services in a health care organization. Following are The Joint Commission's elements of performance for prevention of central line-associated bloodstream infections (National Patient Safety Goal #7).

More information

Link to the PCS Regulatory Readiness site and National Patient Safety Goal #7 resources

Magnet Recognition

Magnet_logoThe American Nurses Credentialing Center (ANCC) requires Magnet-designated organizations to track nationally-benchmarked nursing sensitive indicators (NSIs) to continually inform improvement efforts related enhance patient outcomes. Examples of NSIs include, but are not limited to: patient falls, hospital-acquired pressure ulcers, blood stream infections, ventilator-associated pneumonia, and restraint use.

GLOSSARY OF TERMS
There are numerous terms and acronyms in healthcare that may be unfamiliar. Please click here to visit a Glossary of Terms that may be helpful. And please email any suggested additions.

This month's featured term: CLABSIs
Central Line-Associated Bloodstream infection (CLABSI). When a patient gets a bloodstream infection after having a central line put in and the bloodstream infection is not related to an infection in another part of the body it’s considered a CLABSI.   According to the Centers for Disease Control and Prevention (CDC), an estimated 248,000 CLABSIs occur in U.S. hospitals each year.  These bloodstream infections often lead to longer hospital stays, higher costs, and an increased risk of dying.  CLABSIs can be prevented through proper insertion and care of the central line.

Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.

If you have questions or suggestions related to the EED portal, please contact Georgia Peirce at (617) 724-9865 or via email at gwpeirce@partners.org.

updated 7/31/15

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