Central Line Bundle

From the Institute for Healthcare Improvement

Implement the Central Line Bundle

Central venous catheters (CVCs) are being increasingly used in the inpatient and outpatient settings to provide long-term venous access. CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible. Infection may spread to the bloodstream (bacteremia) and hemodynamic changes and organ dysfunction (severe sepsis) may ensue possibly leading to death. Approximately 90 percent of the catheter-related bloodstream infections (BSIs) occur with CVCs.

Forty-eight percent of ICU patients have central venous catheters, accounting for 15 million central venous catheter-days per year in ICUs. Studies of catheter-related bloodstream infections that control for the underlying severity of illness suggest that attributable mortality for these infections is between 4 and 20 percent. Thus, it is estimated that between 500 and 4,000 US patients die annually due to bloodstream infections.

In addition, nosocomial bloodstream infections prolong hospitalization by a mean of 7 days. Estimates of attributable cost per bloodstream infection are estimated to be between $3,700 to $29,000.

Care bundles, in general, are groupings of best practices with respect to a disease process that individually improve care, but when applied together result in substantially greater improvement. The science supporting the bundle components is sufficiently established to be considered standard of care.

The Central Line Bundle is a group of evidence-based interventions for patients with intravascular central catheters that, when implemented together, result in better outcomes than when implemented individually.

The key components of the Central Line Bundle are:

Hand Hygiene
Maximal Barrier Precautions Upon Insertion
Chlorhexidine Skin Antisepsis
Optimal Catheter Site Selection, with Subclavian Vein as the Preferred Site for Non-Tunneled Catheters
Daily Review of Line Necessity with Prompt Removal of Unnecessary Lines