1. Care of the patientswith invasive line inintensive careDr.Hardik patel.INTENSIVISTR.B.S. MAHAVIR HOSPITAL,SURAT.

2. Objective: 3. Complication related to CVC LINE uses areknown to increase patients morbidity andmortality and increases costs and length ofhospital stay. Education programs to promote best centralline practice have been shown to reduce CVCcomplication. Purpose, to demostrate the effectiveness ofuse of bundle,care and policy to reducesthe cvc related compli.. 4. Overview of CVCThe main types of CVCs are:a) Nontunneled CVCsb) Tunneled CVCsc) Peripherally inserted central catheters (PICCS)d) Implanted ports 5. a) Nontunneled CVCUsed for short-term therapyInserted percutaneouslySubclavian veinInternal jugular veinFemoral veinHas from 1 to 5 lumens or portsUsually from 15 to 30 cm in length 6. b) Tunneled CVCUsed for long-term therapy Inserted surgically or may be inserted byInterventional Radiology Small Dacron cuff sits in subcutaneoustunnel No dressing is required after cuff healsunless the patient isimmunocompromised Line initially sutured with sutures removed in710 days External portion of the catheter can berepaired 7. c)Peripherally Inserted CentralCatheters (PICCs) Used for short-, intermediate-, and long-termtherapy May be single, dual, or triple lumen Inserted percutaneouslyo Basilic veino Brachial veino Cephalic vein Advanced into the superior vena cava to thejuncture of the SVC and right atrium. 8. d) Implantable Ports Used for long-term therapies Surgically implanted Consists of metal, titanium, or plastichousing with a densesilicone septum in the center Catheter placed in superior vena cava Accessed with a special needle with adeflected tip Dressing required until insertion sitehealed 9. Challanges Two main challenges in intravenous (IV)therapy arethe prevention of infectionandthe maintenance of patency. 10. CVC related complication Why we need Invasive lines? Contra indication Pathogenesis of CVC related infection(CLABSI,CRBSI). Measure to reduce the infection. 11. Contraindication 12. Optimal position of CVC 13. CVC line related complication 14. Pathogenesis Crnich and Maki elegantly, Pathogenic organisms canenter the extraluminal or intraluminal surface of anindwelling vascular device. They suggested that the major sources are either devicecolonization or infusion of contaminated fluid. 15. Organism access to the device surface occurs by either:1. Invasion of the percutaneous tract (during insertion orin the subsequent days)2. Contamination of the catheter hub during guidewireinsertion or during manipulation3. Seeding from a remote source of localized infection. 16. Formation of BIOFILM 17. Concern with CVC LINE CRBSI: Clinical definition, defined by precise laboratoryfindings that identify the CVC as the source of the BSIand, used to determine diagnosis, treatment, andpossibly epidemiology of BSI in patients with a CVC. CLABSI: Used only for surveillance purposes to identifyBSIs that occur in the population at risk (patients withcentral lines). 18. Diagnosis of CRBSI CRBSI criteria require one of the following:A) Positive semi quantitative (>15 colony-forming units[CFU]/catheter segment) or quantitative (>103CFU/cathetersegment) cultures whereby the same organism (speciesand antibiogram) is isolated from the catheter segmentand peripheral bloodB) Simultaneous quantitative blood cultures with a 5:1ratio CVC versus peripheral blood.C) Differential period of CVC culture versus peripheralblood culture positivity of >2 hours (DTTP). 19. Prevention of CRBSI The reduction was associated with theimplementation of multiple interventionsincluding targeted surveillance, prompt review of CRBSI cases, weekly team meetings, and regular reporting to clinical areas. 20. CRBSI BUNDLEHAND HYGIENECHLOR HEXIDINE SKIN ANTISEPSISSTERILE GOWN AND MAXIMUM BARRIERPRECAUTION WITH LINE INSERTIONDAILY REVIEW OF LINE NECCESITY 21. CVC related care 22. Accessing CVC lines 23. CVC dressing overview 24. How to remove the dressing? 25. Clean site with chlorhexidine 26. Put a Bio patch. 27. SUMMARY The hospital policy recommendation andits implementation, regular data analysisand review new implementation and activeparticipation of team member involving inthe patient care are require to preventCRBSI. 28. The BSI rate in patients with central linesis calculated using the following formula, BSIs in patients with central linescentral line days 1000. The device utilization (DU) ratio is ameasure of patient days in which centrallines were used. central line dayspatient days