The majority of central line related air emboli reported in NSW occurred during line removal. In most cases the patient being sat up was seen as a major contributing factor.
An effective awareness campaign could be extremely useful in focussing staff on an important message:
CENTRAL LINES ARE REMOVED SUPINE
We’re creating a brief animation clearly explaining why the supine position is important for central line removal.
We’ve contacted manufacturers of sterile dressings placed over central lines requesting the message be imprinted clearly on the edge of the dressing.
We’ve contacted the Australian Commision on Safety and Quality in Healthcare requesting they alter the current central line labels (see below) to carry the same message.
Central Lines should only be removed by staff trained to do so.
‘CENTRAL LINES ARE REMOVED SUPINE’
But what if I can’t lie flat or have observations outside normal limits?
Potential guideline for central line removal in patients unable to lie flat (further ideas welcome):
1. Contact critical care medical officer.
2. Consider delaying removal if patients physiological status likely to improve
3. Ensure alternative venous access already obtained
4. Consider applying Non Invasive Positive Pressure Ventilation
5. Have most experienced nurse/vascular access nurse remove central line with medical officer in attendance.
6. Remove line in an adequate environment – monitored, with arrest trolley at hand.
7. Patient to remain monitored with nurse in attendance until satisfied occlusive dressing satisfactorily applied.
We’ve asked the Agency for Clinical Innovation and Clinical Excellence Commission to consider guidelines for best practice in event patient unable to lie supine or observations lie outside normal limits to be added to this link: see here