Discharge Instructions: Changing the Dressing on Your Central Line

You are going home with a central line. It’s also called a central venous access device (CVAD) or central venous catheter (CVC). A small, soft tube called a catheter has been put in a vein that leads to your heart. This will be used for a short time (temporary). It provides medicine during your treatment. Where the catheter enters your body, it’s covered with a bandage (dressing). The dressing is often made of clear (transparent) plastic. This helps keep the area germ-free (sterile). To prevent infection, you need to keep the dressing clean and dry. Only change the dressing if you or a caregiver have been told to do so. This sheet explains the process. Also follow any specific instructions from your healthcare provider.

Prevent infection with good hand hygiene

A central line can let germs into your body. This can lead to serious and sometimes fatal infections. To prevent infection, it’s very important that you, your caregivers, and others around you use good hand hygiene. This means washing your hands well with soap and water, and cleaning them with alcohol-based hand gel as directed. Never touch the central line or dressing without first using one of these methods.

To wash your hands with soap and water:

1. Wet your hands with clean water. (Avoid hot water. It can cause skin irritation when you wash your hands often.)

2. Apply enough soap to cover the entire surface of your hands, including your fingers.

3. Rub your hands together briskly for at least 20 seconds. Make sure to rub the front and back of each hand up to the wrist, your fingers and fingernails, between the fingers, and each thumb.

4. Rinse your hands with clean water.

5. Dry your hands completely with a new, unused paper towel. Don’t use a cloth towel or other reusable towel. These can harbor germs.

6. Use the paper towel to turn off the faucet, then throw it away. If you’re in a bathroom, also use a paper towel to open the door instead of touching the handle.

When you don’t have access to soap and water: Use alcohol-based hand gel to clean your hands. Allow the hand gel to dry completely. The gel should have at least 60% alcohol. Follow the instructions on the package. Your healthcare team can answer any questions you have about when to use hand gel, or when it’s better to wash with soap and water.

When to change the dressing

• If you have a transparent bandage (dressing), change it every 7 days (or more often if instructed).

• If you have a gauze dressing, change it every 2 days. This includes gauze under a transparent dressing.

• If the dressing becomes loose, dirty, or wet, change it right away. Report this to your healthcare provider as soon as possible.

Preventing infection while changing the dressing

The central line provides a direct path into your bloodstream. So the chance of a serious infection is high as you change the dressing. Don’t touch the catheter where it enters the skin. And be very careful to keep your work area and supplies clean. Following the steps on this sheet will help. Keep in mind that some supplies come in sterile (germ-free) packaging. Make sure to keep these sterile during the dressing change.

Supplies for changing the dressing

A general list of supplies is below. Your healthcare team will provide you with a list of specific items and brands to use. Or you may get a kit that has everything you need. Your supplies may include:

• Gauze dressing

• Transparent dressing

• Antimicrobial sponge disk

• Antiseptic supplies to clean the skin and around the catheter exit site (such as chlorhexidine plus alcohol)

• Sterile gloves

• Nonsterile gloves and a mask

• Medical tape, adhesive strips, or a securement device

Before you start, review the steps below and make sure you understand them. If you’re not sure what to do or how to use your supplies, ask a member of your healthcare team before you try to change the dressing.

Step 1. Wash your hands

Wash your hands well with soap and water. Use the method described above.

Step 2. Prepare your work area

• Choose an area with a hard, flat surface where you can easily spread out the supplies, such as a desk or table. Don’t use the bathroom. There are too many germs.

• Put pets and children out of the work area. Keep them out until the dressing change is done.

• Clean washable surfaces with soap and water. Dry with a clean, unused paper towel. Then throw the paper towel away.

• Spread clean, unused paper towels over your work surface. Use as many as you need to cover it.

• If you need to cough or sneeze, move away from your work surface first.

Step 3. Lay out your supplies

• Clean your hands with soap and water or hand gel. Do this before you lay out your supplies on the work surface.

• After cleaning your hands, only touch your supplies. If you do touch anything else, such as furniture or your clothes, clean your hands again. This is very important for preventing infection.

• Place your supplies on the cleaned and dried work surface. Lay them out in the order you will be using them.

• If you’re using a kit with a sterile tray, take off the plastic covering. Remove the covering only. Don't open the tray. Keep the plastic covering to dispose of the old dressing.

Step 4. Remove the old dressing

• Put on clean, nonsterile gloves and a mask. Anyone who is helping you change the dressing should do this, too. (Don’t use your sterile gloves for this step. Sterile gloves are used in Step 5.)

• Take off the old dressing by gently pulling the edges. Carefully peel off the dressing in the direction of the catheter site. While doing this, hold the end of the catheter (the lumen) so it doesn’t pull out of your body.

• If a securement device is in place, carefully remove it using the method your nurse showed you.

• Check the catheter site for signs of infection such as redness, swelling, drainage, or a bad odor. If you notice any, call your healthcare team when you’re finished changing the dressing.

• Wrap the old dressing in plastic (if available) and put it aside.

Step 5. Prepare sterile supplies

• Remove your nonsterile gloves. Clean your hands with hand gel. You should still be wearing the mask.

• Open any sterile supplies, such as the transparent dressing and sterile gloves. Follow the directions on the package and your healthcare team’s instructions.

• Put on sterile gloves. Follow the directions on the package or as you were shown in the hospital.

Step 6. Clean the catheter site

• If the skin under the dressing has dried blood or a lot of drainage, clean it as directed by your healthcare team.

• Clean the catheter exit site using the antiseptic supplies your healthcare team recommends. It’s very important to follow the package directions and your provider’s instructions exactly.

Step 7. Apply the new dressing

• If you’re using a gauze dressing, apply it over the catheter exit site the way your nurse showed you.

• If you’re using an antimicrobial sponge disc, place it around the catheter with the correct side touching your skin. Line up the slit on the sponge disk with the catheter.

• Apply the transparent dressing over the catheter exit site and over the gauze or sponge disk (if used). Put the top end down first. Then smooth out the rest across the area where the catheter exits your skin. Make sure the dressing covers the entire catheter.

• Take off and discard the sterile gloves and mask.

• Tape the end of the catheter (lumen) to your skin.

• Throw away the old dressing and used supplies.

• Wash your hands.

Changing the injection caps

The catheter’s injection caps need to be changed every 3 to 7 days. This is often done at the same time as the dressing change. Your healthcare provider will give you instructions.

Risk of blood clot

If a blood clot forms, it can block blood flow through the vein where the catheter is placed. Signs of a blood clot include pain or swelling in your neck, face, check, or arm. If you have any of these symptoms, call your healthcare provider right away. You may need an ultrasound exam to find the blood clot and be treated with a blood thinner.

When to seek medical care

Call your healthcare provider right away if you have any of the following:

• Pain or burning in your shoulder, chest, back, arm, or leg

• Fever of 100.4° F ( 38.0°C ) or higher, or as advised by your healthcare provider

• Chills

• Signs of infection at the catheter site (pain, redness, drainage, burning, or stinging)

• Coughing, wheezing, or shortness of breath

• A racing or irregular heartbeat

• Muscle stiffness or trouble moving

• Gurgling noises coming from the catheter

• The catheter falls out, breaks, cracks, leaks, or has other damage