Making Central Lines SAFER

Summary

The “Making Central Lines SAFER” initiative is a comprehensive Health System-wide program to decrease complications, both mechanical and infectious, from resident-performed central venous access (CVA).

This program was initiated in September 2016 in to address the need for consistent, uniform central venous access technique and training for our GME (Graduate Medical Education) programs. After only one year the Making Central Line SAFER program has had dramatic results, eliminating major procedural complications and drastically reducing central line associated blood stream infections (CLABSI). This program has standardized the techniques, equipment, and training for CVA, saving the health system financial resources and patient-complications.

Comprehensive Training & Competency Testing

Comprehensive Training
All departments agreed on a single standardized technique for CVA. The didactic and hands-on training program that includes a cadaver-based procedural competency evaluation was based on this standardized technique. The didactic training was developed in conjunction with the Departments of Surgery (Steven Holsten, MD) and Epidemiology (Julie Hammond, RN), and consists of 3 parts: appropriate aseptic technique and CVA Bundle, ultrasound guidance for needle insertion, and best practices for CVA technique. The hands-on workshop covers each of these areas, reinforcing the mechanical aspects of these tasks. All residents and fellows who perform CVA are required to attend the comprehensive training and complete the hands-on workshop stations.

Competency Testing
Following completion of the training, residents participate in a CVA cadaver-based competency test. Residents perform the CVA procedure including the CVA bundle in conjunction with a certifying nurse (ED/ICU AUMC nurse). The resident performance is evaluated using a standardized grading rubric by a faculty physician. The grading rubric is divided into major tasks (failure of a major task results in failure of the competency testing) and minor tasks (a resident passes if he/she does not fail more than 3 minor tasks). Residents must pass the standardized competency evaluation prior to independent performance of CVA.