# Central line insertion bundle: preventing bloodstream infection at the time of placement

Source: https://onco.cc/protocols/central-line-insertion-bundle/  
OnCo record `central-line-insertion-bundle` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When a central line is put in, the team follows a checklist: clean hands, a cap, mask, sterile gown and gloves for the person inserting it, a sterile drape over the whole body, and chlorhexidine in alcohol on the skin, left to dry. Someone watches and can stop the procedure if a step is missed. For long treatments such as chemotherapy, a tunnelled line or a port is usually the right kind of line.

## Summary

The insertion bundle in SHEA/IDSA/APIC 2022 is a set of essential practices: an evidence-based list of indications (low quality), education and competency of inserters (moderate), a process such as a checklist with an empowered observer (moderate), hand hygiene (moderate), an all-inclusive cart or kit (moderate), ultrasound guidance (high), maximum sterile barrier precautions with cap, mask, sterile gown, sterile gloves and a full-body drape (moderate; CDC IB; epic3 Class C), and alcoholic chlorhexidine skin preparation of at least 2% allowed to dry (high; epic3 Class A; CDC IA at more than 0.5%). Site choice: subclavian preferred for non-tunnelled lines in the ICU (high) and avoid the femoral vein in adults (CDC IA); in children the femoral site may be considered when upper sites are contraindicated. Use the fewest lumens needed (CDC IB, epic3 Class A); for long-term access use a tunnelled line or implanted port (epic3 Class A); PICCs are not a strategy to lower infection risk (SHEA). No systemic antibiotic prophylaxis at insertion (SHEA high, CDC IB, epic3 Class A). Replace a line placed in an emergency without assured asepsis within 48 hours (CDC IB). Antiseptic- or antimicrobial-impregnated catheters are an additional approach where rates stay high.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: CLABSI insertion bundle; central line insertion checklist; CVC insertion bundle; maximal sterile barrier precautions; line insertion asepsis
- Tags: protocol; clabsi; vascular-access

## Connected records

- protocols: [Central line maintenance bundle: preventing bloodstream infection after insertion](https://onco.cc/protocols/central-line-maintenance-bundle/), [Central venous catheter insertion for anticancer treatment: PICC, tunnelled line and implanted port](https://onco.cc/protocols/central-venous-catheter-insertion-for-anticancer-therapy/), [Implanted port access, flushing and care in adults having cancer treatment](https://onco.cc/protocols/implanted-port-access-and-care/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/)

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