These tools will help your unit implement evidence-based practices and eliminate central line-associated blood stream infections (CLABSI). When used with the CUSP (Comprehensive Unit-based Safety Program) Toolkit, these tools dramatically reduced CLABSI rates in more than 1,000 hospitals across the country.
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 5 supervised lines in one site, he or she is independent for that site only. A total of 3 supervised rewires 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. If a correction is required, make a check mark in the “Yes With Reminder” column and note the correction in the comment space. Report uncorrected deviations and complications of line placement. Contact the attending if any item on the checklist is not adhered to or if there are any concerns. Return this completed form to the designated person in your area.
Operator: ________________________ Supervisor: ________________________