Certification of Central
Venous Lines
Georgia Health Sciences Medical Center
Augusta, Georgia
November 13, 2012
The Joint Commission
National Patient Safety Goal #7
2010
“Reduce the risk of healthcare associated
infections”
NPSG.07.04.01
Implement best practice or evidence based
guidelines to prevent central line associated
bloodstream infections.
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Elements of the Central Line Bundle:
 Hand hygiene
 Maximal barrier precautions upon insertion
 Chlorhexidine skin antisepsis
 Optimal catheter site selection, with avoidance
of using the femoral vein for central venous
access in adult patients
 Daily review of line necessity, with prompt
removal of unnecessary lines
What is a “Certified Line”?
 Inserted by a “Qualified Inserter”
 Witnessed by a “Qualified Observer”
 Having at least 2 people present at all times during the insertion
procedure.
 Verified by the “Qualified Observer” through
documentation in the medical record that:
 All components of the CVL Bundle were followed, and
 No breaks in sterile/aseptic technique occurred
 Documented as “certified” in the medical
record by the “Qualified Observer”
 All components of the bundle must be followed with no breaks in
sterile/aseptic technique.
 NOTE:If components of the “bundle” are not adhered to,
documentation by the “Qualified Inserter” indicates appropriate reason
deviation occurred and can still be certified.
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“Certified Line”
=
“Qualified Inserter”
+
“Qualified Observer”
(A non-certified line should be removed
within 24 hours of insertion.)
Who is a “Qualified Inserter”?
A Physician, PA or Advanced Practice RN who
has met these two criteria:
 Successfully checked off by their service as competent
in the insertion of central lines and credentialed for
CVL insertion
 Successfully demonstrated competent use of the CVL
Bundle by attending the CVL Bundle Program
sponsored by Hospital Epidemiology
Who is a “Qualified Observer”:
 Vascular Access Teams (AVAT/PVAT)
Pediatric and Adult ICUs
General Nursing Units
 Registered Nurses in:
Interventional Radiology
Emergency Department
Operating Rooms (circulating nurses)
Critical Care Units
Pediatric Units
Adult Vascular Access Team AVAT
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 13 members
24/7 Coverage
 Preferred first contact for central line
insertion observation
 Routine maintenance for all central lines
 Insertion of PICC lines
Pediatric Vascular Access TeamPVAT
 8 PVAT members
 CMC Coverage
 Preferred first contact for central line
insertion observation
 Routine maintenance for all central lines
 Insertion of PICC lines
Computerized Physician Order Entry(CPOE)
Activates the VATs
CPOE Continued
CVL Bundle Program
Consists of:
 1 hour didactic class
 National Patient Safety Goals
 Central Line Bundle
 Hospital Policy
 Policy access on the intranet
 Basic Asepsis within surgical field
 Competency demonstration in a simulated lab
 Skills assessed:
 Surgical scrub / Donning sterile attire
 Skin prep / draping / Central Line Bundle
 Dressing & antimicrobial disc application
 Documentation of insertion and bundle
 Access to policies/procedures on line
CVL Bundle Program
Upon successful completion of the program a badge
is given to identify them as a “Qualified Inserter”
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Next Step
Incorporate “Qualified Inserter” verification into the
Procedure Time Out process and documentation using
the “red” Asepsis (CVL Bundle) Program badge.