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Table 3 APSIC central line maintenance checklist

From: APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI)

Name of patient

 

Age

 

Sex

 

Unique ID

 

Name of Treating physician/Surgeon

     

Unit

 

Type of Central Venous Catheter

Tunneled

 

Non-Tunneled

 

PICC line

 

Chemoport

 

Any other:

 

Days

1

2

3

4

5

6

7

Date

       

The maintenance procedure

Y

N

Comment:

Y

N

Comment:

Y

N

Comment:

Y

N

Comment:

Y

N

Comment:

Y

N

Comment:

Y

N

Comment:

date for change in dressing, date of IV set change

date for change in dressing, date of IV set change

date for change in dressing, date of IV set change

date for change in dressing, date of IV set change

date for change in dressing, date of IV set change

date for change in dressing, date of IV set change

date for change in dressing, date of IV set change

Is review done for need for central line use?

                     

Was hand hygiene practised before all line maintenance/access procedures?

                     

Was alcohol used to disinfect hub before each access?

                     

Was dressing changed using aseptic technique?

                     

Were administration sets replaced every 4-7 days?

                     

Signature of person in-charge:

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