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Central Line Utilization Message
A message on behalf of Andy Anderson, MD, Chief Medical and Quality Officer; and Fariborz Rezai, MD, System Director, Critical Care Medicine
We are enthusiastic about the progress our facilities are making toward achieving our goal of a 25 percent improvement, with a stretch goal of a 50 percent improvement, in Central Line Associated Bloodstream Infections (CLABSI). We thank you for your engagement and responsiveness to onsite team members from Vizient® who have been assisting our clinical teams in this important work.
One key measure in achieving our goals is appropriate utilization of central lines. A reduction in central line placements equates with a meaningful reduction of CLABSI. We must maintain a questioning vigilance around both the clinical need for central line placement and the duration of time that the central line remains in place.
When ordering a central line, please keep in mind:
- For the vast majority of patients, a central line (CVC or PICC) should only be considered if there is a need for vasopressors or total parenteral nutrition.
- If a patient does not have vascular access, a peripheral line should be the first choice and a midline as an alternative.
- The need for blood draws or vascular access does not justify the need for a central line.
- 16 cm central venous catheters should be used for the right IJ and 20 cm central venous catheters used for other sites.
- PICC lines should never be hubbed. They should be secured at the zero mark, which is approximately one centimeter from the hub. The zero mark is the widest part of the catheter which will help prevent bleeding and infectious complications.
When assessing appropriate central line removal times:
- Generally, all patients leaving the ICU should have their central line removed.
- When a patient has a central line, it is recommended to assess the continued need for that line at least twice a day.
Thank you for your dedication to RWJBarnabas Health, our patients, our communities and your colleagues.
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