Central venous catheters (CVCs), including jugular, subclavian and femoral lines, PICCs, tunnelled lines and ports, are used for long-term IV medicines, chemotherapy, parenteral nutrition, vasopressors and haemodialysis. They are also a leading cause of central line-associated bloodstream infections (CLABSIs), which increase deaths and costs. Most CLABSIs are preventable with consistent care — work largely done by nurses.
Insertion bundle
Many hospitals use evidence-based bundles (such as those promoted by the US CDC and the Institute for Healthcare Improvement). At insertion, nurses often support or monitor compliance with:
- Hand hygiene.
- Maximal sterile barrier precautions: cap, mask, sterile gown and gloves, and a full-body sterile drape.
- Chlorhexidine (2%) in alcohol skin antisepsis, allowed to dry.
- Optimal site selection (avoiding the femoral vein in adults where possible).
- Ultrasound guidance.
- Use of a checklist, with authority to stop the procedure if sterility is breached.
Maintenance bundle
- Daily review: is the line still needed? Remove promptly when it isn’t.
- Hand hygiene before every contact.
- Scrub the hub (needle-free connector) with chlorhexidine-alcohol for at least 15 seconds and let it dry before every access.
- Dressing: sterile, transparent semi-permeable dressing; change every 7 days, or sooner if wet, soiled or loose (gauze dressings every 2 days). Chlorhexidine-impregnated dressings are used in many units.
- Change administration sets per policy (more often for blood products and lipids).
- Minimise breaks in the closed system.
- Document line type, insertion date, site inspection and dressing changes.
Flushing and patency
- Flush with 0.9% sodium chloride before and after each use, using a 10 mL or larger syringe (smaller syringes generate high pressure and can rupture catheters).
- Use a pulsatile (push-pause) technique and positive-pressure clamping.
- Lock lines per policy (saline or heparin).
- Never force a flush against resistance; report occlusion.
Recognising infection
- Fever, rigors (especially when the line is flushed), or signs of sepsis without another source.
- Redness, tenderness, swelling or pus at the exit site or along the tunnel.
- Take blood cultures from the line and peripherally, as requested, and follow the sepsis pathway.
Air embolism: prevention
- Keep connections secure; clamp lines before changing caps or sets.
- For removal of jugular or subclavian lines, position the patient flat or head-down (Trendelenburg) if tolerated, and ask them to hold their breath or exhale at the moment of removal (or remove during expiration).
- Apply pressure, then an occlusive dressing for at least 24 hours; keep the patient lying flat for about 30 minutes afterwards.
- Signs of air embolism: sudden breathlessness, chest pain, low BP, confusion. Turn the patient onto the left side, head down, give high-flow oxygen and call for help.
Related: Peripheral IV cannulation · Hand hygiene
Based on CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, epic3 and Infusion Nurses Society standards. Educational content: follow local policy.