ChecklistandCVC

2015DrROSAY

Unitéd’accèsvasculaireDARCLBLyon

ProvonostP BerenholtzSM

Toerrishuman

Preven6onofCathetersRelatedBloodstreamInfec6ons

BerenholtzSM,CritCareMed,2004

Compliancewiththeb

undle

Preven6onofCathetersRelatedBloodstreamInfec6ons

BerenholtzSM,CritCareMed,2004

STAGE5:Stopinterven6onbythenursesin32%ofcases

Preven6onofCathetersRelatedBloodstreamInfec6ons

SICU

CSICU

Educa6on

CVCtrolley

Check-list

Interven6on

11.3

0

0.5

16monthslater

Preven6onofCathetersRelatedBloodstreamInfec6ons

•  103ICU,•  Teamleaders(Physician+Nurse),educa6on•  «bundle»:

– Washhandsimmediatlyprior,– Sterilizeproceduresitewithchlorhexidine– Surgicaldressingduringtheprocess– Avoidfemoralloca6on– Revoveunnecessarycatheters Pronovostetal,NEJM2006

Preven6onofCathetersRelatedBloodstreamInfec6ons

0

1

2

3

4

5

6

Baseli

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Penda

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m4-6

m.

7-9 m

.

10-12

m.

13-15

m.

16-18

m.

25ème P Médiane 75ème P

Pronovostetal,NEJM2007

Risk reduction: 66%

1500livessaved75Millions$saved

•  MainbenefitsofChecklists:– Helptomemoryrecall– Makeexplicittheminimumexpectedstepsincomplexprocesses

•  Checklistsestablishedahigherstandartofbaselineperformance,thebestcompliancetobundle

Ifsomethingsoeasycantransformintensivecare,Whynotwouldwedoit

forallCVC?

Thesechecklististarge6ng5fundamentalpoints

Beforetheact Duringtheact AHertheact

1-EsKmatetherisks

3-PeroperaKveverificaKonofthecatheterfuncKonality

2-Compliancewithhygieneprocedures

4-PostoperaKvecontrolofCatheterKplocaKonandabsenceofcomplicaKons

5-Traceability

Instruc6onsbeforetheact•  Iden6ty•  Consent•  Riskassessment:bleeding,allergic,

AnatomicalCI,Pathology...•  Equipmentinser6onsiteaccordingtothe

condi6on,thedura6ones6matedusefulcontext...

•  Choiceofequipmentaccordingtotheindica6on

•  Skinprepara6on:shearingifnecessary,atleastashower(includingshampoo)withsoap;toiletonthebedclosertoplacement.

•  Monitoring.•  CheckingtheEquipment•  Ultrasounds:probecoversandsterilegels

Instruc6ons:duringtheact•  Hygieneprocedures•  Fric6on,cleaning,disinfec6ngwithalcohol

an6sep6c•  Termsofsurgicalasepsis

–  surgicaldressing–  Implementa6onofsteriledrapes

coveringthefield:maximumbarrier•  Checkingduringopera6on

–  Mechanical–  Posi6onal–  Func6onal

•  Ifdeferreduse:closetheCVC/VDwithalockfluidinjectedthroughavalvebidirec6onalscrew(Luerlock).

•  Protec6onwithocclusivesteriledressing.

Instruc6ons:adertheplacement•  Verifica6ondistalendofthe

catheter:imagery?•  Traceability/Repor6ng:date,

pa6entiden6tyandoperator,typeofmaterialandbatchnumber,

•  Layingcondi6ons,inser6onsite,numberofpuncturesandpossiblecomplica6ons

•  Dataskeptinthemedicalfilepa6ent

•  Pa6entinforma6onCVC/DV:infobooklet:typeVD,basicrules.

•  PhonesandContactsincaseofemergency…

•  Checklistapprovedbythe“CollegeHAS”,January27,2011andon-linethesitetobeavailabletoprofessionalswhowishtouseit.

•  Thischecklistisnotobligatoryinthecer6fica6onofhospital,like"Pa6entsafetyblockopera6ve"whomprac6ceisobligatoryandaPriority,since1January2010

ChecklistCVC

•  Physician’sfeelingsaboutthislist:–  Itisuseful–  Itisgoodforyoung–  itisusefulforteaching–  Itdoesnotprotectusincaseofclaims–  itmakesuslossour6me–  itverifiesthecri6calpoints–  itavoidsoversights,errors

Ø Itimprovesecurity

FrenchChecklistEvalua6on

•  lillefrequentuse•  noresultsavailableexceptsomerareICU•  speciallyrareinlong-terminfec6onsTPN,dialysis,oncology

•  Notevidenceofiteffec6veness;•  Noepidemiology•  Notobligatory

Limitsoffrenchchecklist

Donotputthecartbeforethehorse

Weneedassessment

Forallyourprojects,ifyouwantsomeresults:

Behave like a duck

Above the water, and collected

look calm

Under the water, paddle like mad