# PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line

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

## TL;DR

A PICC (a thin tube in the arm) or a tunnelled line (in the chest) needs regular care: a clear sealed dressing changed about once a week, the end cap cleaned before every use, and a salt-water flush to keep it open. Keep it dry and out of baths and swimming pools, and call your team if it gets red, sore, leaks, will not flush or you get a fever.

## Summary

Line care rests on general central line infection-prevention guidance rather than oncology trials. Hand hygiene (CDC IB) and aseptic technique (NICE CG139). Skin antisepsis at dressing changes with 2% chlorhexidine in 70% alcohol, allowed to dry (epic3 Class A; CDC IA for above 0.5% chlorhexidine with alcohol). A sterile transparent or gauze dressing covers the site (CDC IA); gauze while the site oozes or the patient sweats (CDC II). Transparent dressings are changed at least every 7 days and gauze every 2 days, or sooner if damp, loose or soiled (SHEA, moderate quality, non-tunnelled lines; NICE; epic3); for tunnelled or implanted lines CDC says no more than weekly until the site heals (II), and neither CDC nor epic3 settles whether a healed tunnelled exit site needs a dressing at all.

Chlorhexidine-containing dressings are an essential practice in SHEA 2022 (high quality, acute care), epic3 says consider them (Class B) and NICE supports Tegaderm CHG in critically ill adults; SHEA says their value for long-term catheters with healed sites is unclear. Hubs, needleless connectors and injection ports are disinfected before every access (CDC IA; SHEA moderate), with at least 5 seconds of friction (SHEA) or 15 seconds (epic3). Antiseptic caps are an additional practice in SHEA; NICE found insufficient evidence for routine use of Curos. Flush with saline after every use (ESMO [II, B]) and lock frequently accessed lumens with saline (epic3 Class A); the Cochrane review (2022) found heparin locks may reduce occlusion on low-certainty evidence. Sutureless securement (CDC II). No submersion; showers with the line covered (CDC IB). No antibiotic ointment on the site (CDC IB). Remove the line when it is no longer needed (SHEA moderate).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: PICC care; PICC dressing change; Hickman line care; tunnelled line care; central line dressing; scrub the hub; needleless connector care; bionector change; line flush; CVC maintenance; CHG dressing

## Connected records

- protocols: [Blocked central line or port: assessment and clearing with a thrombolytic](https://onco.cc/protocols/central-line-occlusion-management/), [Blood sampling from a central line or port](https://onco.cc/protocols/blood-sampling-from-a-central-line/), [Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay](https://onco.cc/protocols/catheter-related-thrombosis-in-cancer/), [Central line and port care in the community and at home](https://onco.cc/protocols/community-care-of-vascular-access-devices/), [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/), [Choosing a venous access device for anticancer treatment: port, PICC, tunnelled line or cannula](https://onco.cc/protocols/venous-access-device-selection-for-anticancer-therapy/), [Implanted port access, flushing and care in adults having cancer treatment](https://onco.cc/protocols/implanted-port-access-and-care/), [Suspected central line infection in a person with cancer: paired blood cultures, first antibiotics and line removal or salvage](https://onco.cc/protocols/suspected-central-line-infection/)
- technologies: [Catheter lock solutions (heparin, taurolidine and DefenCath)](https://onco.cc/technologies/catheter-lock-solutions/), [Catheter securement devices and dressings (SecurAcath, Tegaderm CHG)](https://onco.cc/technologies/catheter-securement-devices/), [Disinfecting caps for needleless connectors (Curos)](https://onco.cc/technologies/needleless-connector-disinfecting-caps/), [Infusion pumps, ports, and ambulatory chemotherapy devices](https://onco.cc/technologies/infusion-devices-vascular-access/), [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/)
- ideas: [Test antiseptic caps on the connectors of PICCs and tunnelled lines in people having cancer treatment at home](https://onco.cc/ideas/idea-upgrade-antiseptic-caps-for-long-term-lines-at-home/)

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