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If you go home with a PICC, tunnelled line or port, a community or district nurse may look after it, or you or a carer may be taught to. You should be shown what to do before you leave hospital, have someone to ask afterwards, and the nurse should clean their hands, use a clean no-touch technique, change the clear dressing weekly and clean the end of the line before and after use.
NICE CG139 (2012, updated 2017) is the UK guideline for infection prevention in primary and community care, and NICE QS61 (2014) statement 5 makes vascular access device care a quality standard: people with a device should have their infection risk minimised by completing specified procedures for insertion and maintenance, and by removal as soon as it is no longer needed, with a written protocol as the structure measure. Before discharge, patients and carers are taught any techniques they need to prevent infection and manage the device, with follow-up training and support available; community staff are trained and assessed as competent. The care itself is the hospital standard: hand decontamination before access or dressing; aseptic technique (ANTT named as one framework); a sterile transparent dressing over a central line changed every 7 days or sooner if lifting or damp; chlorhexidine in 70% alcohol on the hub before and after access (QS61 adds a 15-second clean, from epic3); saline to flush and lock; and daily inspection of central line sites. Many of these recommendations date from 2003 and none is graded.
Why: Most of the time with a line is spent at home, and problems start there.
“Before discharge from hospital, patients and their carers should be taught any techniques they may need to use to prevent infection and safely manage a vascular access device.”
NICE 2012 · [2003, amended 2012]
Why: Skills fade and questions arise once people are home.
“Follow-up training and support should be available to patients with a vascular access device and their carers.”
NICE 2012 · [2003, amended 2012]
Why: Community nurses may care for central lines only occasionally, so training and checks keep standards consistent.
“Healthcare workers caring for a patient with a vascular access device should be trained, and assessed as competent, in using and consistently adhering to the infection prevention practices described in this guideline.”
NICE 2012 · [2003, amended 2012]
Why: Hands are the commonest route by which germs reach a line.
“Hands must be decontaminated (see section 1.1.2 on hand decontamination ) before accessing or dressing a vascular access device.”
NICE 2012 · [new 2012]
Why: Keeping key parts untouched stops germs entering the line in a home setting without hospital facilities.
“An aseptic technique must be used for vascular access device catheter site care and when accessing the system”
NICE 2012 · [new 2012]
Why: A sealed dressing keeps germs out; a loose or damp one lets them in.
“Change the transparent semipermeable membrane dressing covering a central venous access device insertion site every 7 days, or sooner if the dressing is no longer intact or moisture collects under it.”
NICE 2012 · [2012]
Why: The hub is touched every time the line is used and is a main route for infection.
“Decontaminate the injection port or vascular access device catheter hub before and after accessing the system using chlorhexidine gluconate in 70% alcohol.”
NICE 2012 · [new 2012]
Why: Flushing keeps the line open; saline avoids the risks of heparin for most devices.
“Preferably, a sterile 0.9 percent sodium chloride injection should be used to flush and lock catheter lumens.”
NICE 2012 · [2003]
Why: Daily checks catch infection early; a line that is not needed only adds risk.
“Central venous catheter insertion sites should be inspected daily.”
Why: QS61 measures quality by whether every specified step is done for every person with a device.
“People who need a vascular access device have their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the device and its removal as soon as it is no longer needed.”
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
In the UK, NICE CG139 and QS61 statement 5 set the standard for line care outside hospital: patient and carer teaching before discharge with follow-up support, trained and assessed staff, hand decontamination, aseptic technique, a transparent dressing changed every 7 days on central lines, hub decontamination with chlorhexidine in alcohol before and after access, saline flush and lock, daily site inspection and removal when no longer needed, all under a written protocol. The clinical steps match the hospital guidelines (CDC, epic3, ESMO) set out in the port and PICC care protocols; the community-specific additions are the teaching, support and competence recommendations, which date from 2003 and are ungraded.
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Shares Catheter securement devices and dressings (SecurAcath, Tegaderm CHG), Blood sampling from a central line or port, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).
Shares Blood sampling from a central line or port, Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).
Shares Blood sampling from a central line or port, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Central venous access (port, PICC line).
Shares Blocked central line or port: assessment and clearing with a thrombolytic, Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).
Shares Blocked central line or port: assessment and clearing with a thrombolytic, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Central venous access (port, PICC line).
Shares Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Central venous access (port, PICC line).
Shares Blocked central line or port: assessment and clearing with a thrombolytic, Implanted port access, flushing and care in adults having cancer treatment, Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Central venous access (port, PICC line).