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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.
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).
Why: Hands are the commonest route by which germs reach a line.
“Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter.”
CDC/HICPAC 2011 · Category IB
Why: The tip of the line sits in a large vein near the heart, so anything touching the connector must stay sterile.
“An aseptic technique must be used for vascular access device catheter site care and when accessing the system”
NICE 2012 · [new 2012]
Why: Infection and a line slipping out are easiest to catch at the dressing change.
“Monitor the catheter sites visually when changing the dressing or by palpation through an intact dressing on a regular basis, depending on the clinical situation of the individual patient.”
CDC/HICPAC 2011 · Category IB
Why: Chlorhexidine with alcohol kills skin bacteria best, and works fully only once dry.
“Use a single-use application of 2% chlorhexidine gluconate in 70% isopropyl alcohol (or povidone iodine in alcohol for patients with sensitivity to chlorhexidine) to clean the central catheter insertion site during dressing changes, and allow to air dry.”
Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 · Class A
Why: A clear dressing lets the site be checked without removing it; gauze absorbs blood or sweat that would lift a clear one.
“Use either sterile gauze or sterile, transparent, semipermeable dressing to cover the catheter site”
CDC/HICPAC 2011 · Category IA
Why: A lifted or wet dressing lets germs in; changing a sound one too often irritates the skin and disturbs the line.
“For non-tunneled CVCs in adults and children, change transparent dressings and perform site care with a chlorhexidine-based antiseptic at least every 7 days or immediately if the dressing is soiled, loose, or damp. Change gauze dressings every 2 days or earlier if the dressing is soiled, loose, or damp (Quality of Evidence: MODERATE)”
SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022 · Quality of Evidence: MODERATE
Why: In trials, mostly in intensive care, these dressings reduced line bloodstream infections.
“Use chlorhexidine-containing dressings for CVCs in patients over 2 months of age (Quality of Evidence: HIGH)”
SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022 · Quality of Evidence: HIGH
Why: A line that moves in and out carries germs in and can slip out of position.
“Use a sutureless securement device to reduce the risk of infection for intravascular catheters”
CDC/HICPAC 2011 · Category II
Why: The connector is touched many times a day; it is a main route for germs into a long-term line.
“Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and accessing the port only with sterile devices”
CDC/HICPAC 2011 · Category IA
Why: Rubbing removes the film of germs on the connector; a few seconds are not enough.
“Apply mechanical friction for a minimum of 5 seconds to reduce contamination.”
SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022
Why: Changing connectors more often adds handling without reducing infection.
“Change needleless connectors no more frequently than every 72 hours or according to manufacturers’ Recommendations for the purpose of reducing infection rates”
CDC/HICPAC 2011 · Category II
Why: Flushing clears blood and drugs that would otherwise block the line or mix in it.
“Use sterile normal saline for injection to flush and lock catheter lumens that are accessed frequently.”
Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 · Class A
Why: It encourages fungal infection and resistant bacteria.
“Do not use topical antibiotic ointment or creams on insertion sites, except for dialysis catheters, because of their potential to promote fungal infections and antimicrobial resistance”
CDC/HICPAC 2011 · Category IB
Why: Soaking the site lets water and germs under the dressing.
“Do not submerge the catheter or catheter site in water. Showering should be permitted if precautions can be taken to reduce the likelihood of introducing organisms into the catheter (e.g., if the catheter and connecting device are protected with an impermeable cover during the shower)”
CDC/HICPAC 2011 · Category IB
Why: Problems usually start between visits, and the person with the line sees them first.
“Encourage patients to report any changes in their catheter site or any new discomfort to their provider.”
CDC/HICPAC 2011 · Category II
Why: Every day a line stays in carries a risk of infection and clots.
“Remove nonessential catheters (Quality of Evidence: MODERATE)”
SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022 · Quality of Evidence: MODERATE
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.
Hand hygiene and aseptic technique; 2% chlorhexidine in alcohol on the skin, dried (epic3 Class A); a sterile transparent dressing (gauze while oozing) changed at least every 7 days, gauze every 2 days, sooner if compromised (SHEA moderate; NICE; CDC IB for damp or loose dressings); a chlorhexidine-containing dressing where available (SHEA high quality, acute care; epic3 Class B, consider); sutureless securement (CDC II); hub scrubbed before every access (CDC IA), for at least 5 seconds (SHEA) or 15 seconds (epic3); saline flush after every use (ESMO [II, B]; epic3 Class A); no submersion. The guidance differs on chlorhexidine dressings for long-term lines in healed sites (SHEA: benefit unclear) and on antiseptic caps (SHEA additional practice; NICE: insufficient evidence for routine use).
CDC/HICPAC 2011 · SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022 · Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 · NICE 2012 · ESMO (Annals of Oncology, Sousa et al.) 2015 · NICE 2019 · NICE 2019
Where it differs: A cap holding alcohol is left on each needleless connector between uses, replacing or adding to the manual scrub.
Evidence: SHEA 2022 lists antiseptic-containing caps as an additional practice despite high-level evidence, because they are not considered superior to manual disinfection, and lists as unresolved whether a scrub is still needed under a cap. NICE (HealthTech guidance 510, 2019) found Curos promising but the evidence insufficient for routine NHS adoption, and recommended research including people managed in the community.
SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022 · NICE 2019
Where it differs: Uses a dressing that releases chlorhexidine at the insertion site instead of a standard transparent dressing.
Evidence: SHEA 2022: essential practice, high quality, but unclear for long-term catheters in well-healed sites. epic3 IVAD20: consider (Class B). NICE HealthTech guidance 379 supports Tegaderm CHG for central and arterial lines in critically ill adults, estimating a saving of £93 per patient at a baseline infection rate of 1.48 per 1,000 catheter days.
SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022 · Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 · NICE 2019
Where it differs: Locks the line with heparinised saline after the saline flush, instead of saline alone; common for tunnelled lines.
Evidence: Cochrane 2022 (12 RCTs, 2422 adults, two oncology studies): heparin may give fewer occlusions (RR 0.70, 95% CI 0.51 to 0.95, low certainty), with no clear difference in patency duration, line infection, bleeding or heparin-induced thrombocytopenia (very low certainty). epic3 recommends saline for frequently accessed lumens (Class A).
Cochrane Database of Systematic Reviews 2022 · Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014
Where it differs: Leaves the well-healed exit site of a cuffed tunnelled line uncovered.
Evidence: epic3 says a dressing may no longer be required once the site has healed (Class D/GPP); CDC makes no recommendation (unresolved issue).
Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 · CDC/HICPAC 2011
An antiseptic cap that sits on the end of a line's connector between uses may lower infections. The evidence comes mostly from hospital wards and intensive care; for people with cancer who live at home with a PICC or tunnelled line for months, NICE found too little evidence and asked for research.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Replace a dressing that becomes damp, loosened or visibly soiled “Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled” | Category IB | CDC/HICPAC 2011 |
| Tunnelled or implanted sites: transparent dressings no more than weekly until healed “Replace transparent dressings used on tunneled or implanted CVC sites no more than once per week (unless the dressing is soiled or loose), until the insertion site has healed.” | Category II | CDC/HICPAC 2011 |
| No recommendation on dressing well-healed exit sites of long-term tunnelled lines “No recommendation can be made regarding the necessity for any dressing on well- healed exit sites of long-term cuffed and tunneled CVCs.” | Unresolved issue | CDC/HICPAC 2011 |
| Tunnelled or implanted sites: dressing every 7 days until healed; may not be needed once healed “Dressings used on tunnelled or implanted catheter insertion sites should be replaced every 7 days until the insertion site has healed unless there is an indication to change them sooner. A dressing may no longer be required once the insertion site has healed.” | Class D/GPP | Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 |
| Consider a chlorhexidine-impregnated sponge dressing in adults with a central line “Consider the use of a chlorhexidine-impregnated sponge dressing in adult patients with a central venous catheter as a strategy to reduce catheter-related bloodstream infection.” | Class B | Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 |
| Disinfect hubs, needleless connectors and injection ports before access “Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter (Quality of Evidence: MODERATE)” | Quality of Evidence: MODERATE | SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology, Buetti et al.) 2022 |
| Saline flush after any infusion or blood sample “Routine flushing with saline, after the completion of any infusion or blood sampling, is recommended” | [II, B] | ESMO (Annals of Oncology, Sousa et al.) 2015 |
| Daily 2% chlorhexidine skin wash “Use a 2% chlorhexidine wash for daily skin cleansing to reduce CRBSI” | Category II | CDC/HICPAC 2011 |
| Curos disinfecting cap: insufficient evidence for routine adoption “Curos disinfecting cap shows promise for preventing infections when using needleless connectors, but there is currently insufficient evidence to support the case for routine adoption in the NHS.” | NICE HealthTech recommendation (not graded) | NICE 2019 |
Shares Catheter lock solutions (heparin, taurolidine and DefenCath), Disinfecting caps for needleless connectors (Curos), Suspected central line infection in a person with cancer: paired blood cultures, first antibiotics and line removal or salvage, Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay.
Shares Suspected central line infection in a person with cancer: paired blood cultures, first antibiotics and line removal or salvage, Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay, Peripherally inserted central catheters (PICC lines), Central venous access (port, PICC line).
Shares Implanted port access, flushing and care in adults having cancer treatment, Peripherally inserted central catheters (PICC lines), Central venous access (port, PICC line).
Shares Catheter lock solutions (heparin, taurolidine and DefenCath), Disinfecting caps for needleless connectors (Curos), Peripherally inserted central catheters (PICC lines), Infusion pumps, ports, and ambulatory chemotherapy devices.
Shares Catheter securement devices and dressings (SecurAcath, Tegaderm CHG), Infusion pumps, ports, and ambulatory chemotherapy devices.
Shares Peripherally inserted central catheters (PICC lines), Infusion pumps, ports, and ambulatory chemotherapy devices, Central venous access (port, PICC line).
Shares Catheter lock solutions (heparin, taurolidine and DefenCath), Disinfecting caps for needleless connectors (Curos), Peripherally inserted central catheters (PICC lines), Central venous access (port, PICC line).
Shares Implanted port access, flushing and care in adults having cancer treatment, Infusion pumps, ports, and ambulatory chemotherapy devices, Central venous access (port, PICC line).