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. 2016 May 4;5:16. doi: 10.1186/s13756-016-0116-5

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:
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: