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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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Other Topics: Anticoagulation | CAUTI | Central Lines | Diversity | Downtime (internal access only)

Ethics | Evidence-Based Practice | Fall Prevention | Pain | Patient Education/Health Literacy | Patient Experience
Practice Alerts & Updates (internal access only) | Pressure Injuries | Process Improvement | Professional Development
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Epic Documentation | Epic Communication

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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

Outpatient Settings FAQ
BIOPATCH® use with Implanted Ports
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

 

 

 

Implanted Ports (Visual Guide)

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

Implanted Central Venous Access Devices (Ports) Teaching Module

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

 

 

Pink PICC line wrist bands

The PICC wrist bands have limited information on them: the type of catheter, length and number of lumens. The IV Team sees the pink bracelets as a better identifier of patients with PICC lines and will help 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 STATSEAL CVC  click here        

PICC line Removal & Checklist click here

StatLock PICC Plus securement device click here

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

PICC Teaching module click here

 


Non-tunneled Central Venous Catheters
(Visual Guide)

Overview click here

Removal click here

Non-tunneled central catheter teaching module click here


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

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

CLABSI prevention efforts spearheaded by the Infection Control Unit include the use of a CHG dressing (Biopatch) at the insertion site for all central lines since 2013 (see policy for exceptions) and the use of alcohol cap needleless port protectors (Curos Caps), added in 2015, that are placed on the unused ports of every IV in a patient that has a central line.

Early CLABSI prevention interventions (in place since 2009) continue and include:

  • Use of a standardized central line insertion kit
  • Use of a central line insertion checklist, now found in Epic,  and the presence of a monitor to ensure all steps for safe line placement are taken
  • Use of chlorhexidine for skin prep
  • Use of  maximal sterile barriers
  • Use of color coded stickers to identify a line that was placed according to infection control policy, versus those placed in emergent situations -Provision of feedback on CLABSI cases identified in ICU patients. Upon identification of a CLABSI on the unit, Infection Control informs unit leadership so they can investigate possible root causes and opportunities for learning

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.

 

PATIENT EDUCATION

Implanted Ports: What You Need to Know click here

Preventing Central Line Bloodstream Infections click here

Peripherally Inserted Central Catheter (PICC) Teaching Booklet for Patient and Family 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. 


Patients with End Stage Renal Disease

Vein Preservation 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

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 4/15/19

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