ࡱ> =?<_ bjbj 4$bb 2222N42]]] $7 v2]]]]]2Gqqq]v q] qq:,`` ]0R_!_!`_!`]]q]]]]]22q]]]]]]]_!]]]]]]]]] : Central Line Maintenance Audit Form Audit Date: ____/____/20____ Addressograph Here Was the need for a central line for this patient discussed on patient rounds? [ ] Yes [ ] Yes, as part of Daily Goals [ ] No Was proper hand hygiene used by all personnel involved in line care for this patient (i.e., hand washing with soap and water or with alcohol-based hand sanitizer)? [ ] Yes [ ] No, not during: _Dressing change _Accessing the line _Port/clave change _Other If the line was percutaneously placed, was this line placed in a recommended site? [ ] Yes (IJ, SC) [ ] No (femoral) Was the dressing changed during this shift? [ ] Yes, changed because: [ ] Dressing soiled, damp or non-occlusive [ ] Due to be changed (7 days for transparent OR 1 day for gauze) [ ] Changed by specific team (e.g., PICC, TNA) [ ] Dressing was overdue to be changed? ____ days for transparent ____ days for gauze[ ] No, not changed because: [ ] It was intact and not due [ ] It was due but could not be completed. Explain: Was Chloraprep or 2% chlorhexidine in 70% Isopropyl alcohol used for skin antisepsis? [ ] Yes: Was it used appropriately? [ ] Scrub vigorously back and forth for 30 seconds [ ] Groin sites 2 minutes [ ] Air dry up to 2 minutes [ ] No Explain: [ ] No, Povidone iodine used Secondary to allergy? [ ] Yes [ ] No Explain: Did scrub comply with recommendations? Clean with soap and water or alcohol, air dry Povidone iodine air dry 2 minutes [ ] Yes [ ] No Explain:  Were central line tubing and all additions (secondary tubing, etc.) changed during this shift? [ ] Yes, completed because: [ ] Tubing due to be changed [ ] 72 hours since last change [ ] 24 hours for intralipids [ ] Medication tubing expired[ ] No, not completed because [ ] Not due to be changed [ ] Due but could not be completed Explain: Was there blood return from each lumen? [ ] Yes [ ] No [ ] Unable to assess (infusion cant be stopped) Please specify lumen: USE OF ADVANCED TECHNOLOGY Was a chlorhexidine impregnated BioPatch used? [ ] Yes [ ] No Was a chlorhexidine impregnated occlusive dressing used? [ ] Yes [ ] No Was an antibiotic coated catheter used at insertion? 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