Central line care is one of the highest-leverage things a nurse does at the bedside. Insertion gets the attention, but most central-line-associated bloodstream infections (CLABSIs) trace back to what happens to the line over the following days: how it is accessed, how the dressing is maintained, and whether anyone is asking each shift if the line is still needed. Maintenance is nursing work, and small, repeated habits are what hold the bundle together.
Hand Hygiene and Hub Disinfection Are the Daily Core
Every central line interaction starts with hand hygiene. The CDC recommends hand hygiene with soap and water or an alcohol-based rub before and after palpating the insertion site and before and after accessing, dressing, or replacing the catheter. Gloves do not replace it.
The single most repeated maintenance step is disinfecting the access port before every entry, often called "scrub the hub." Scrub the needleless connector or hub with an appropriate antiseptic and access it only with sterile devices. CDC lists chlorhexidine, povidone-iodine, an iodophor, or 70% alcohol as acceptable agents. A systematic review of needleless connector disinfection found that mechanical friction plus adequate contact time is what matters, with alcoholic chlorhexidine offering both immediate and residual activity. Reported effective scrub times in the literature vary, commonly framed as roughly 15 seconds, but defer to your facility policy and the product in use. Two practical points from that review: let the hub dry, because wet antiseptic does not disinfect, and recognize that real-world compliance is often far lower than people assume. Your scrub is only protective if it happens every single time.
Passive disinfection caps, the alcohol- or chlorhexidine-impregnated caps that twist onto an unused port, are a useful adjunct that the review associated with meaningful CLABSI reductions. They do not replace the active scrub when you do access the line.
The hub you do not scrub is the one that seeds the bloodstream. Consistency, not heroics, prevents CLABSI.
Dressings, Securement, and Site Assessment
Inspect the insertion site every shift and with every access. You are looking for redness, drainage, tenderness, and any sign the dressing has lifted. According to CDC and the StatPearls nursing reference, dressing change intervals depend on the dressing type:
- Transparent, semipermeable dressings: change at least every 7 days.
- Gauze dressings: change every 2 days.
- Any dressing that becomes damp, loosened, or visibly soiled: change immediately, regardless of the schedule.
Use a chlorhexidine-based preparation (greater than 0.5% chlorhexidine with alcohol) for skin antisepsis at dressing changes, and let it dry fully before applying the new dressing. Gauze can be used temporarily over a site that is bleeding, oozing, or diaphoretic, but remember that gauze under a transparent dressing counts as a gauze dressing for timing.
Confirm the sutureless securement device is intact at each assessment. A migrating or loose catheter raises infection and dislodgement risk. Date the dressing so the next nurse knows exactly where the schedule stands. Documentation here is not busywork. It is how a shared schedule survives across shifts.
Tubing, Flushing, and Daily Necessity Review
Administration set changes follow defined intervals rather than convenience. For standard continuous infusions, CDC advises replacing tubing no more often than every 96 hours but at least every 7 days. Lipid emulsions, blood products, and propofol have shorter, separate change requirements, so check your policy for those specific infusions.
Flush and lock lumens per policy to maintain patency, keeping the practice consistent for each lumen. Maintaining patency matters because forceful flushing of an occluded line or repeated manipulation creates more entry opportunities.
The highest-yield maintenance step costs nothing: ask every day whether the line is still needed. CDC is explicit that catheters no longer essential should be removed promptly, and routine scheduled replacement is not recommended because it does not lower infection risk. Build the question into rounds and handoff. A line that comes out on day four cannot cause a CLABSI on day six. If you see a line lingering without a clear indication, raise it with the team. You do not need to pull it yourself, but you are well positioned to start the conversation.
Education, Escalation, and Documentation
Patients and families are part of the maintenance team. Teach them to keep the dressing dry and intact, to avoid touching the site and hub, and to tell you about pain, swelling, redness, or drainage. A patient who reports a loose dressing at 2 a.m. is doing exactly what you taught them to do.
Escalate early. New site redness or drainage, fever, rigors with a flush, or signs of sepsis warrant prompt provider notification and, often, blood cultures per policy before any decision about the line. Do not wait for a full picture to communicate a changing one.
Finally, close the loop in the chart. Document site assessment, dressing and tubing change dates, securement status, the daily necessity discussion, education provided, and any escalation. Consistent documentation is what lets a unit audit its own practice, find the gaps, and sustain the gains. CLABSI prevention is not a single dramatic action. It is the same careful steps, done the same way, by every nurse, every shift.