# Central line maintenance bundle: preventing bloodstream infection after insertion

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

## TL;DR

A central line (a Hickman, PICC or port) lets germs straight into the blood, so every touch is planned. Hands are cleaned, the connector is scrubbed with antiseptic each time, the dressing is kept clean and dry and changed weekly, and every day someone asks whether the line is still needed. Families caring for a line at home are taught the same steps before they leave hospital.

## Summary

Maintenance rests on the SHEA/IDSA/APIC 2022 compendium (essential practices for all acute hospitals, graded by quality of evidence), CDC/HICPAC 2011 (updated 2017), epic3 (England, 2014) and NICE CG139 for care at home. Essential: hand hygiene before any contact (epic3 Class A); aseptic technique; scrub hubs, needleless connectors and injection ports before each access (SHEA moderate; CDC IA), with alcoholic chlorhexidine preferred and friction for at least 5 seconds (SHEA) or 15 seconds (epic3 Class D/GPP); access only with sterile devices; chlorhexidine in alcohol for site care at dressing changes (epic3 Class A); transparent dressings changed at least every 7 days and gauze every 2 days, or sooner if soiled, loose or damp (SHEA moderate); chlorhexidine-containing dressings over 2 months of age (SHEA high), which CDC 2017 recommends at IA only from age 18 and leaves unresolved in children; daily review and removal of non-essential lines (SHEA moderate, CDC IA); administration sets up to 7 days (SHEA high) or 96 hours (epic3 Class A); no systemic antimicrobial prophylaxis, routine antibiotic locks or routine line replacement; and unit surveillance of CLABSI per 1,000 catheter days.

Daily chlorhexidine bathing is graded high for ICU patients over 2 months, but SHEA notes benefit in adult haematology-oncology was not seen in children, and a Children's Oncology Group randomised trial (2021) found more CLABSI with chlorhexidine bathing in children with cancer, concluding it does not support routine use. Antiseptic caps, antimicrobial lock therapy for recurrent CLABSI and vascular access teams are additional approaches where rates stay high.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: CLABSI maintenance bundle; central line care bundle; Hickman line care; PICC line care; CVC maintenance; line infection prevention; CRBSI prevention
- Tags: protocol; clabsi; vascular-access; paediatric

## Connected records

- protocols: [Central line and port care in the community and at home](https://onco.cc/protocols/community-care-of-vascular-access-devices/), [Central line insertion bundle: preventing bloodstream infection at the time of placement](https://onco.cc/protocols/central-line-insertion-bundle/), [Hand hygiene in cancer care: staff, patients, families and visitors](https://onco.cc/protocols/hand-hygiene-in-cancer-care/), [Implanted port access, flushing and care in adults having cancer treatment](https://onco.cc/protocols/implanted-port-access-and-care/), [PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line](https://onco.cc/protocols/picc-and-tunnelled-line-care/), [Protective measures and daily life during neutropenia: hand hygiene, visitors, pets, plants, school and swimming](https://onco.cc/protocols/neutropenic-precautions-and-daily-life/)
- cancers: [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [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/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/)

---
JSON: https://onco.cc/api/v1/entities/central-line-maintenance-bundle.json