CL Maintenance Bundle Compliance Audit Form

Month audit completed:b
I. Maintenance Bundle
 CL inserted in an inpatient unit
 CL inserted in a procedural area (excluding operating room and emergency department)
 CL insertion checklist complete and in medical record
 Daily documentation of line necessity
 CL tubing dated?
 Intravenous fluid tubing changed every 24 h?
 Clave clear of blood?
 Dressing intact?
  N/A only applies to the NICU
 Dressing needs to be changed?
  Indications for dressing change needed: dressing not intact, no date of dressing, tegaderm saturated
  N/A only applies for the umbilical lines in the NICU
 Alcohol cap on unused hubs intact?
  N/A only applies to PICC lines in the NICU
 15-s Scrub the Hub visualized?
I. Bundle Reliability
 Have all applicable components of the CL Maintenance Bundle Compliance Audit been met?c
  • N/A, not applicable.

  • a Dashes indicated that N/A was not an option for query.

  • b Month of year circled on form.

  • c An additional response option was “Verbalized.”