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

Table 3 APSIC central line maintenance checklist

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:
The maintenance procedure	Y	N	date for change in dressing, date of IV set change	Y	N	date for change in dressing, date of IV set change	Y	N	date for change in dressing, date of IV set change	Y	N	date for change in dressing, date of IV set change	Y	N	date for change in dressing, date of IV set change	Y	N	date for change in dressing, date of IV set change	Y	N	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:

ISSN: 2047-2994