How often should central line dressings be changed?

Central Line Dressing Change Frequency Guidelines

For central venous catheters, transparent dressings should be changed every 7 days, while gauze dressings should be changed every 2 days. 1, 2

Dressing Change Schedule by Type

• Transparent dressings:

  • Change every 7 days for non-tunneled central venous catheters 1, 2
  • Transparent dressings allow continuous visual inspection of the insertion site 1, 2
  • In a randomized controlled trial, changing transparent dressings every 7 days was shown to be non-inferior to changing them every 3 days for preventing catheter colonization 3

• Gauze dressings:

  • Change every 2 days 1, 2
  • Preferred when there is bleeding, oozing, or drainage at the insertion site 1, 2
  • Should be replaced by transparent dressings once bleeding or drainage resolves 1

Special Circumstances Requiring Immediate Dressing Change

• Dressings must be changed immediately when they become:

  • Soiled 1, 2
  • Loose 1, 2
  • Damp 1, 2

• A study of chemotherapy patients found that with once-weekly dressing changes, 42% required unplanned changes sooner, primarily due to soiling or bleeding, resulting in a real mean interval of 5.4 days between changes 4

Population-Specific Considerations

• Tunneled catheters:

  • After healing period (approximately 3 weeks), it remains unclear if a dressing is necessary 1, 2
  • For well-healed exit sites in children with tunneled catheters, it is recommended to have catheters looped and covered 1, 2

• Neonatal ICU patients:

  • A randomized controlled trial in NICU found that regular weekly dressing changes resulted in significantly lower catheter-related bloodstream infection rates (0‰) compared to non-regular changes (2.0‰) 5
  • Less frequent dressing changes may be considered for NICU patients at high risk for serious complications from catheter dislodgement 1

• High-risk patients:

  • Consider chlorhexidine-impregnated dressings for patients older than two months with short-term catheters who are at high risk for infection 1
  • A specialized vascular access team performing dressing changes has been shown to reduce central line-associated bloodstream infections by 36.1% in high-risk immunocompromised patients 6

Infection Prevention Best Practices

• Clean the insertion site with 2% chlorhexidine gluconate in 70% isopropyl alcohol before applying a new dressing 1
• Allow the antiseptic to completely air dry before applying the new dressing 1
• Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter 1
• Consider passive disinfection using caps containing disinfectant agents (e.g., 70% isopropyl alcohol) over needleless connectors 1

Common Pitfalls to Avoid

• Avoid using topical antimicrobial ointments at the insertion site as they may promote fungal infections, antimicrobial resistance, and damage the catheter surface 1, 2
• Do not use organic solvents (e.g., acetone, ether) on the skin before or after applying antiseptic 1
• Avoid sutures for securing catheters when possible, as they may increase the risk of contamination at the exit site 1
• In diaphoretic patients, dressings may need to be changed more frequently than the standard schedule 2