Central Line Insertion Care Team Checklist

This checklist provides sequential critical steps that have shown to reduce central line-associated infections.

Clinicians can take steps to prevent central line-associated infections. This checklist from Johns Hopkins Medicine provides critical steps that have been shown to reduce these infections. It also stresses the need to document any deviations from the checklist.

A print version of this document from The Johns Hopkins Hospital Interdisciplinary Clinical Practice Manual is available at http://www.hopkinsmedicine.org/quality_safety_research_group/_files/clabsi_toolkit/Appendix_L_Central_Line_Insertion_Checklist.pdf

Central Line Insertion Care Team Checklist

Patient Name __________________
Hx # ________________
Unit _________________
Date/Time ____________

A minimum of 5 supervised successful procedures in both the chest and femoral sites is required (10 total). If a physician successfully performs the 5 supervised lines in one site, they are independent for that site only. A total of 3 supervised re-wires is required prior to performing a rewire independently.

Supervisor Role: 2nd-year resident and above (approved for line placement).

Assistant Role: RN, ClinTech, MD, NP, PA (responsible for completing checklist).

If there is a deviation in any of the critical steps, immediately notify the operator and stop the procedure until corrected. If a correction is required, make a check mark in the "Yes with reminder" column and note what correction was made in the comment space, if applicable. Uncorrected deviations and complications of line placement are to be reported. Contact the Attending if any item on the checklist is not adhered to or with any concerns. Please return completed form to the designated person in your area.

Before the procedure, did the operator:

Critical StepsYesYes With ReminderReport Completed for Procedure Deviation?Comments:
Obtain informed consent?    
Obtain supervision if needed (see roles above)?   N/A [  ]
Perform a time-out/briefing?    
Confirm hand washing/sanitizing immediately prior?    
Operator(s):cap, mask, sterile gown/gloves, eye protection?    
Supervisor: cap, mask, sterile gown/gloves, eye protection?   N/A [  ]
Assistant: cap, mask, isolation gown, and gloves, eye protection (if at risk for entering sterile field, use sterile gown and gloves)?    
Properly position to prevent air embolism?
For Chest/EJ: Trendelenburg (HOB <0 degrees)
For Femoral: supine
Sterilize procedure site (chlorhexidine)?    
Allow site to dry?    
Use sterile technique to drape from head to toe?    
Utilize local anesthetic and/or sedation?   N/A [  ]

During the procedure, did the operator:

Critical StepsYesYes With ReminderReport Completed for Procedure Deviation?Comments:
Maintain a sterile field?    
Monitor that lumens were not cut?   N/A [  ]
Clamp any ports not used during insertion (to avoid air embolism, clamp all but distal port)?   N/A [  ]
Obtain qualified second operator after 3 unsuccessful sticks (except if emergent)?   N/A [  ]
Aspirate blood from each lumen (to avoid air embolism and ensure intravascular placement)?    
Transduce CVP or estimate CVP by fluid column (to avoid arterial placement)?   N/A for fluoroscopy procedures [  ]

After the procedure, did the operator:

Critical StepsYesYes With ReminderReport Completed for Procedure Deviation?Comments:
Clean blood from site using antiseptic agent (chlorhexidine), apply sterile dressing    
Verify placement by x-ray (tip in SVC/RA junction)   N/A for fluoroscopy procedures [  ]

Operator: ________________________

Supervisor: _______________________

Assistant: ________________________

Page last reviewed May 2009
Internet Citation: Central Line Insertion Care Team Checklist. May 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cli-checklist/index.html