Central Line Dressing Changes & CLABSI Prevention

Part of the ICU Devices Hub — browse every related guide in one place.

Updated July 2026  |  More ICU nursing guides →

A central line bloodstream infection (CLABSI) is one of the most preventable disasters in critical care — and prevention is almost entirely nursing work. The line gets placed by a provider once; it gets maintained by nurses dozens of times a day. Most CLABSIs trace not to insertion but to what happens at the hub and under the dressing over the following days. This is a practical ICU guide to the maintenance bundle, the dressing change, and the daily habits that keep the catheter clean.

Insertion vs. maintenance: know which battle you're in

CLABSI prevention has two bundles. The insertion bundle (hand hygiene, maximal sterile barriers, chlorhexidine skin prep, optimal site selection avoiding the femoral where possible, and a checklist with stop-the-line authority) is a one-time event, and nurses often serve as the checklist observer empowered to halt a break in sterility. The maintenance bundle is the daily, repeating one — and it's where bedside nurses prevent the most infections:

• Meticulous hand hygiene before any line contact.
• Scrub the hub before every access.
• Aseptic technique for dressing and cap/tubing changes.
• Daily review of line necessity — remove the line the day it's no longer needed.

Scrub the hub — the highest-frequency defense

Every time a hub, cap, or connector is accessed is an opportunity to push skin flora into the bloodstream. Scrub the hub with the appropriate antiseptic (alcohol or CHG per policy) using friction for the required time — commonly around 15 seconds — and then let it dry before connecting. The drying is not optional; a wet antiseptic hasn't finished working. This tiny ritual, done every single access by every clinician, prevents more CLABSIs than almost anything else because of how often it's performed.

When to change the dressing

Dressing type drives the interval, and both are usually set by policy:

The "change it now" trigger overrides the calendar. A dressing that is lifting at the edges, moist, or soiled is no longer a barrier — it's a culture medium. Don't reinforce a failing dressing with more tape; change it.

The dressing change, step by step

Perform the change with aseptic (sterile) technique using a central-line dressing kit and a mask (and patient mask/turned head per policy):

1. Perform hand hygiene and gather supplies; explain the process to the patient.
2. Apply a mask; don clean gloves and carefully remove the old dressing, lifting toward the insertion site to avoid dislodging the catheter. Note the external catheter length/markings.
3. Inspect the site: assess for redness, drainage, tenderness, swelling, and confirm the catheter hasn't migrated.
4. Perform hand hygiene again and don sterile gloves.
5. Cleanse with a chlorhexidine (CHG) applicator using friction, per manufacturer directions, and allow it to dry fully.
6. Apply the securement device/CHG-impregnated patch (if used) and the new sterile dressing; label with date, time, and initials.

CHG dressings, CHG bathing, and daily necessity

Two adjuncts strengthen the bundle in many ICUs: CHG-impregnated dressings at the insertion site and daily CHG bathing of the patient, both of which reduce bloodstream infections in critical care populations. But the most powerful maintenance intervention costs nothing: ask every day whether the line is still needed. The single biggest risk factor for a CLABSI is a catheter that's still in when it no longer has to be. Prompt the team during rounds — early removal beats perfect maintenance.

The nursing bottom line

CLABSIs are prevented at the bedside, one clean access at a time. Scrub every hub and let it dry, change dressings on schedule and immediately when they fail, perform dressing changes with strict aseptic technique and check catheter length each time, use CHG dressings and baths per policy, and above all push to remove the line the day it's no longer necessary. The provider places the catheter; the nurse decides whether it becomes an infection.

Related: arterial line management, ICU sepsis protocol, pressure injury prevention, and restraints in the ICU.