Never skip maximal sterile barrier precautions for a central line insertion.
Before you read
Test yourself first: 5 questions
Question 1 of 5
An infusion pump suddenly stops and displays 'air in line.' The nurse should:
Answer: B. Stop and clear the air: pause the infusion, prime the line to remove air per policy, and resume — do not restart with air in the tubing (air embolism risk).
Question 2 of 5
A nurse is caring for a client in septic shock from a suspected central-line bloodstream infection. Which action takes priority to address the source while supporting resuscitation?
Answer: A. Source control is essential in sepsis. Obtaining blood cultures (ideally before antibiotics if it does not delay them) and administering broad-spectrum antibiotics promptly, while removing the suspected infected central line, addresses the source. Early antibiotics within the first hour improve survival; delaying antibiotics to wait for all results would be harmful.
Question 3 of 5
A nurse is administering a high-alert vasopressor infusion to a client in shock. Which safety measure is most important?
Answer: A. Vasopressors are high-alert medications best delivered through a central line on an infusion pump because extravasation from a peripheral site can cause severe tissue ischemia and necrosis. Free-flowing gravity administration and IM injection are unsafe for titrated vasopressors.
Question 4 of 5
Immediately after a below-the-knee amputation, the nurse notes a small amount of serosanguineous drainage on the residual limb dressing. What is the nurse's priority action?
Answer: B. Because hemorrhage is a serious early postoperative risk, the nurse should outline (mark) the drainage and time on the dressing to monitor for active or increasing bleeding and keep a tourniquet available at the bedside. A small amount of serosanguineous drainage initially is expected, but it must be monitored for progression.
Question 5 of 5
A new graduate nurse is unsure whether a task is within UAP scope. Which resource should the nurse consult first to verify safe delegation?
Answer: A. The state nurse practice act and the facility's policies define legal scope and delegation rules; these are the authoritative sources. Coworkers' opinions, online forums, and assumptions are not reliable for determining legal scope.
Keep the streak going with more questions like these, each with a full rationale.
What is central line bundle?
It spans insertion and maintenance. Core elements: hand hygiene, maximal sterile barriers at insertion, chlorhexidine skin antisepsis, optimal site selection, and daily review of line necessity.
Key points to remember
- The five core elements are hand hygiene, maximal barrier precautions, chlorhexidine skin prep, optimal site selection, and daily necessity review.
- Maximal sterile barriers at insertion include cap, mask, sterile gown, sterile gloves, and a full-body sterile drape.
- Chlorhexidine is the preferred skin antiseptic and must dry fully before insertion.
- The subclavian site generally carries lower infection risk than femoral; femoral is avoided when possible.
- Scrub the hub and needleless connectors before each access (scrub the hub).
- Removing the line as soon as it is no longer needed is a key infection-prevention step.
Nursing priorities
- Perform hand hygiene and ensure full maximal sterile barriers during insertion.
- Prep the skin with chlorhexidine and allow it to dry completely before insertion.
- Scrub the hub or connector with antiseptic before every access.
- Assess line necessity daily and advocate removal when no longer needed.
- Maintain a sterile occlusive dressing and change it per protocol or when soiled or loose.
Labs & values
Patient teaching
- Keep the dressing clean, dry, and intact and report if it loosens or gets wet.
- Report fever, chills, or redness and tenderness at the insertion site.
Red flags: report now
- Never skip maximal sterile barrier precautions for a central line insertion.
- Do not leave a central line in place once it is no longer clinically needed.
- Report redness, drainage, or fever, which may signal a bloodstream infection.
References
Clinical references for this topic
