Catheters Give Life but Sometimes Take It

4. Optimal catheter site selection

“Percutaneously inserted catheters are the most commonly-used central catheters,” IHI researchers say. “Several risk factors have been identified, however, that are associated with bloodstream infections. These include the site of placement. Whenever possible, and not contraindicated, the subclavian line site should be preferred over the jugular and femoral sites for non-tunneled catheters in adult patients.”

It is necessary to assess daily whether the central line is still necessary. It is common for central lines to stay in place simply because the caregiver has not considered taking them out. This is a critical misstep, as it’s clear that infection risks increase the longer a line remains. Daily review should be part of multidisciplinary rounds.¹ Record the time and date of line placement and make this information accessible to staff so they can draw upon it when making decisions.

Barriers to Bundling

Bundling is a simple idea overall, but many factors thwart it. According to Perl, one main barrier to proper bundling is that some employees may not know why bundling is important. Logistics are also vital. “Do you have the equipment you need, does the equipment work, does the institution make it easy for you to perform the correct behaviors?” Perl suggests asking. Staff also may not support bundling if they do not receive reinforcing factors such as outcome measures, Perl adds.