ALERT: How to prevent central line associated blood stream infections (CLABSI) at home?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
ALERT: How to prevent central line associated blood stream infections (CLABSI) at home?
SITUATION:
This Quick Hit was informed by Virtual Visits with family caregivers who reported concerns about risk of infection for their children with central venous access devices (CVADs) at home.
BACKGROUND:
Many children with medical complexity rely on CVADs in home and community care for long-term intravenous therapy including medication administration, parenteral nutrition, dialysis, hydration, and blood sampling. Types of CVADs include central venous lines (CVL) and peripherally inserted central catheters (PICC).
Central Line Associated Blood Stream Infections (CLABSI) are serious infections that occur when microorganisms enter the bloodstream through the central line. The image below demonstrates how bacteria can enter the bloodstream through the insertion site and/or catheter hub.
ASSESSMENT:
CLABSIs are preventable and can cause significant harm to children including readmission to hospital and/or removal of the central line. When caring for a child with a CVAD, assess the insertion site and surrounding skin regularly.
Signs and symptoms of a CLABSI may include:
Fever
Pain
Redness
Swelling
Drainage or discharge
RECOMMENDATION:
Connected Care recommends the following evidence-based strategies to mitigate the risk of CLABSIs in home and community care:
Assess the child’s CVAD site and dressing integrity regularly throughout the day. Replace the dressing if it becomes damp, loosened or visibly soiled.
Partner with the child’s family caregiver and clinical team on an ongoing basis to discuss the functioning, use and necessity of the CVAD
Ensure that the child has a bath daily and protect the CVAD dressing from getting wet during baths. Change the child’s clothing daily and linens at least once weekly.
Scrub the hub of the cap (top and sides) with an alcohol swab for 15 seconds using vigorous friction and allow the cap to air dry for 15 seconds prior to accessing the CVAD (e.g., for flushing, heparin locking, medication administration). This is demonstrated in the image below.
Use single-use supplies when performing CVAD procedures (e.g., using a new syringe for each lumen).
Perform standardized CVAD procedures (e.g., heparin locking, cap change and dressing change) as per orders using aseptic non touch technique. Review the following AboutKidsHealth articles that outline the procedures for heparin locking, cap changes and dressing changes.
Have a Question? Initiate a Consult!
