Central Line Maintenance Observation Tool
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Central Line Maintenance Observation Tool Central Line Maintenance Observation Tool Date: ____________________ Observer Name: ___________________ Date: ____________________ Observer Name: ___________________ Practice Practice Yes No Comments Yes DRESSING CHANGE Wash Hands Put on clean gloves Put on clean gloves Remove dressing Remove dressing Observe site for redness, swelling or discharge Observe site for redness, swelling or discharge Repeat hand hygiene Repeat hand hygiene Open sterile dressing change kit Open sterile dressing change kit Put on mask Put on mask Don sterile gloves Don sterile gloves 1st alcohol swab stick 1st alcohol swab stick 2nd alcohol swab 2nd alcohol swab 3rd swab cleanse catheter/tubing 3rd swab cleanse catheter/tubing CHG swab around site/allow to dry 30 seconds CHG swab around site/allow to dry 30 seconds Apply Biopatch Apply Biopatch Apply dressing Apply dressing ACCESSING LINES: CONNECTING / DISCONNECTING IV FLUIDS / MEDS ACCESSING LINES: CONNECTING / DISCONNECTING IV FLUIDS / MEDS Wash Hands Wash Hands Put on gloves Put on gloves Swab with alcohol 5-10 sec tip & threads of cap Swab with alcohol 5-10 sec tip & threads of cap Connect tubing Connect tubing CONNECTING FLUSH CONNECTING FLUSH Wash hands Wash hands Put on gloves Put on gloves Swab tubing 5-10 seconds Swab tubing 5-10 seconds Attach flush Attach flush Totals X 100% # of proper practice observations # of proper practice observations + # of improper practice observations Please use this tool to complete the CVL Maintenance compliance chart on the PICU bulletin board. Thanks for being a part of this important effort! Comments DRESSING CHANGE Wash Hands Compliance = _________ % No Compliance = _________ % Totals X 100% # of proper practice observations # of proper practice observations + # of improper practice observations Please use this tool to complete the CVL Maintenance compliance chart on the PICU bulletin board. Thanks for being a part of this important effort!
