What is the step‑by‑step sterile technique to remove a temporary catheter cap and replace it with a permanent cap in an adult requiring long‑term hemodialysis or medication infusion, assuming no active infection and adequate coagulation status?

Procedure for Removing Temporary Cap and Replacing with Permanent Cap on Central Venous Catheter

The procedure requires strict aseptic technique with hand hygiene, ensuring catheter clamps are closed, disinfecting the hub with chlorhexidine (or povidone-iodine if contraindicated), removing the old cap without contaminating the hub, and immediately applying a new sterile Luer lock cap while maintaining sterility throughout. 1

Pre-Procedure Preparation

• Explain the procedure to the patient and ask them to minimize talking and turn their head away from the catheter to reduce airborne contamination 1
• Perform hand hygiene using appropriate technique before beginning 1
• Gather all sterile supplies including new sterile Luer lock caps, chlorhexidine antiseptic pads (or povidone-iodine if chlorhexidine contraindicated), sterile gloves, and a clean/sterile pad to place under the catheter 1
• Remove any gauze or tape securing the catheter limbs 1

Step-by-Step Cap Replacement Technique

For Each Catheter Lumen (Repeat for Second Port):

1. Ensure the catheter clamp is completely closed before touching the cap to prevent air embolism or blood loss 1

2. Place a clean or sterile pad/towel under the catheter so the limbs rest on top of the sterile field 1

3. Don sterile or clean gloves depending on institutional protocol 1

4. Disinfect the existing cap and hub junction with chlorhexidine (or povidone-iodine alternative) using the "scrub-the-hub" technique before removal 1

   • This optional step reduces contamination risk during cap removal 1

5. Remove the Luer lock cap by unscrewing it while maintaining the clamp in closed position 1

6. Immediately disinfect the exposed catheter hub with a fresh chlorhexidine antiseptic pad using vigorous scrubbing motion 1

   • Use a separate antiseptic pad for each hub 1
   • Allow the antiseptic to dry completely according to manufacturer recommendations before applying the new cap 1

7. Ensure the disinfected hub does not touch any non-sterile surfaces during the interval between cleaning and cap application 1

8. Attach the new sterile Luer lock cap immediately after the hub is dry, screwing it on securely 1

9. Verify the clamp remains closed after cap replacement 1

10. Repeat the entire process for the second catheter lumen using fresh supplies 1

Critical Safety Points

• Caps must be replaced every single time the catheter is accessed and de-accessed to maintain infection prevention standards 1
• If using closed-system, high-flow needleless caps, follow the manufacturer's specific recommendations for cleaning and changing intervals 1
• Never reuse caps or allow contaminated caps to remain in place 1
• Maintain one-lumen-at-a-time technique to minimize the time blood remains stagnant in each lumen 1

Common Pitfalls to Avoid

• Do not open the catheter clamp during cap changes as this creates risk for air embolism or hemorrhage 1
• Do not touch the catheter hub with non-sterile gloves or allow it to contact non-sterile surfaces after disinfection, as this is a primary source of catheter-related bloodstream infections 1
• Do not rush the antiseptic drying time, as inadequate drying reduces antimicrobial efficacy 1
• Do not use topical antibiotic ointments on the catheter hub (except for hemodialysis catheters at exit sites), as this promotes fungal infections and antimicrobial resistance 1

Post-Procedure

• Discard all used supplies appropriately 1
• Document the cap change including date, time, and any complications 1
• Educate patients to report any pain, fever, chills, redness, or discharge at the catheter site immediately 1