Central line dressing change: a step-by-step nursing guide

Changing a central line dressing is one of the highest-stakes sterile procedures a nurse performs at the bedside. A dressing that is done correctly – with full sterile technique, correct CHG antisepsis, and a secure, air-pocket-free transparent film – forms a physical barrier between the catheter insertion site and the microbial environment of a hospital room. A dressing done poorly – rushed, with contaminated gloves, or applied over a wet site – can contribute to a central line–associated bloodstream infection (CLABSI). In a meta-analysis of 18 mostly ICU studies, CLABSI was associated with higher in-hospital mortality (odds ratio 2.75 overall and 1.51 in studies matched for illness severity), although the CDC notes that catheter-related bloodstream infections have not generally been shown to raise mortality independently, so the attributable share is debated (Ziegler 2015; CDC 2011). Longer hospital stays and higher costs are well established.

This guide covers the complete central line dressing change procedure for nursing students: supplies, step-by-step sterile technique, site assessment criteria, dressing selection decisions, securement device options, INS-standard change frequencies, complication flags, and NCLEX high-yield points.

For central venous catheter types, insertion, and hemodynamic monitoring, see the central line nursing overview. For PICC-specific maintenance including flushing, blood draws, and daily PICC care, see PICC line care.

When the dressing is due

CDC 2011 and SHEA 2022 set the following change frequencies for central venous catheter dressings, and the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice, 9th edition (2024), use the same intervals:

• Transparent semipermeable membrane (TSM) dressing: at least every 7 days, or immediately when damp, soiled, loose, or no longer fully adhering
• Gauze-based dressing: every 2 days, or sooner when damp, soiled, or loose
• CHG-impregnated disc or CHG gel dressing: replaced with each dressing change. SHEA 2022 recommends chlorhexidine-containing dressings for CVCs in patients over 2 months of age (high-quality evidence).

The 7-day interval is a maximum, not a target. A transparent dressing that begins lifting at one corner on day 4 is not a day-7 dressing – it needs changing today. Any break in dressing integrity restores the exposure pathway from skin flora to the catheter insertion site.

Supplies

Gather all supplies before entering the patient’s room. Opening packaging at the bedside while gloved wastes time and increases the risk of contaminating your sterile field.

Standard central line dressing kit includes:

• Sterile gloves (correct size)
• Non-sterile gloves (for initial removal)
• Face mask – for the nurse, and for the patient if they cannot turn their head away (most facility protocols)
• CHG/isopropyl alcohol (2% CHG in 70% IPA) swabs or applicator
• CHG-impregnated disc (Biopatch or equivalent)
• Transparent semipermeable membrane dressing (e.g., Tegaderm, IV3000) – or sterile gauze and tape if clinically indicated
• Catheter stabilization device (StatLock or equivalent – check whether replacement is due)
• Date/time label
• Sterile gauze squares (2×2 or 4×4)
• Sterile drape (included in most kits)

Step-by-step procedure

Preparation (before gloves)

1. Perform hand hygiene using soap and water or alcohol-based hand rub. This is the first action – not the second or third.
2. Explain the procedure to the patient. Ask the patient to turn their face away from the insertion site (or apply a mask to the patient) to reduce droplet contamination of the sterile field during the dressing change. Instruct the patient not to reach toward the site.
3. Don a face mask. Most central line dressing protocols require the nurse to wear a mask throughout the procedure to keep respiratory droplets off the open site and the sterile field.
4. Position the patient to provide clear access to the insertion site. For internal jugular (IJ) or subclavian CVCs, the patient is typically supine with the head turned away from the insertion site. For femoral lines, the patient is supine.
5. Open the dressing kit using sterile technique. Peel the outer packaging without reaching over the inner sterile contents. Create a sterile field on a clean, dry surface adjacent to the patient.

Dressing removal (non-sterile gloves)

6. Don non-sterile gloves. Remove the old dressing by peeling the edges toward the insertion site – not away from it. Pulling the dressing away from the site exerts outward traction on the catheter and can partially dislodge it. Stabilize the external catheter or hub with your non-dominant hand throughout removal.
7. Remove the CHG disc (if present) and dispose. Note any exudate on the disc or under the dressing.

Site assessment (before sterile gloves)

8. With non-sterile gloves still on, inspect the site. Assess for:
   • Erythema (redness extending beyond the expected post-insertion bruise)
   • Swelling or induration at or around the insertion point
   • Drainage – note character (serous, serosanguineous, purulent) and volume
   • Skin breakdown or maceration under the dressing
   • Tenderness on light palpation over the insertion site
9. Measure and document the external catheter length (the length of catheter visible outside the skin, from the insertion point to the hub). Compare to the baseline length documented at insertion or the last dressing change. Any change from baseline must be reported to the provider before proceeding. A catheter that has migrated inward may have an incorrectly positioned tip; a catheter that has migrated outward may have a tip no longer in the SVC.
10. Remove non-sterile gloves and perform hand hygiene.

Antisepsis and dressing application (sterile gloves)

11. Don sterile gloves. From this point, sterile technique applies. Do not touch any non-sterile surface – including the bed rail, the patient’s skin outside the prepared field, or your own face mask – without changing gloves.
12. Cleanse the insertion site with CHG/IPA. Using the CHG applicator, scrub the whole area the dressing will cover with gentle back-and-forth friction. For ChloraPrep, the label gives 30 seconds on a dry site (such as the chest or arm) and 2 minutes on a moist site such as the inguinal fold, which applies to femoral lines. Back-and-forth friction is the CHG technique; the center-outward concentric circle belongs to povidone-iodine.
13. Allow to dry completely. The ChloraPrep label gives about 30 seconds of air drying on a dry site and about 1 minute on a moist site. Do not blot, wipe, or fan the area. A dressing applied over wet antiseptic traps the solution against the skin, which raises the risk of skin irritation and reduces adhesion, and CDC 2011 and SHEA 2022 both call for the antiseptic to dry before the next step.
14. Apply the CHG-impregnated disc around the catheter at the insertion site. For a Biopatch foam disc, the white antimicrobial side goes against the skin and the printed blue side faces up; slide the catheter into the radial slit so the slit edges touch. The disc must lie flat on the skin, not ride on the catheter. If your unit uses a TSM dressing with a built-in CHG gel pad instead, position the gel pad over the insertion site per the manufacturer’s instructions and skip the separate disc.
15. Apply the transparent dressing using a no-tension technique:
    • Begin at the center (over the disc and insertion site) and smooth outward to the edges
    • Eliminate all air pockets – air pockets trap moisture and create microenvironments that accelerate bacterial growth
    • Ensure all edges adhere completely – no lifted corners, no wrinkles breaking the seal
    • Frame the edge with the included border strips if present in the kit
16. Secure the catheter with a catheter stabilization device (see securement options below). Place the device under the transparent dressing or at the dressing border per manufacturer instructions. Do not rely on tape alone to secure the catheter; it loosens with moisture and does little to stop the in-and-out movement that can dislodge the catheter.
17. Label the dressing with the date, time of change, and your initials or employee ID.
18. Perform hand hygiene. Document (see documentation section below).

Site assessment criteria

Every dressing change is a mandatory site assessment. Use the criteria below to classify findings and determine your response.

Complication flags requiring provider notification

Notify the physician or provider immediately for any of the following:

• Purulent drainage at the insertion site – an exit-site infection (IDSA 2009) that also needs evaluation for bloodstream infection
• Fever (temperature above 38°C/100.4°F) with any local site finding (erythema, swelling, tenderness)
• Any change in external catheter length from baseline
• Catheter dislodgement – catheter no longer sits at the original insertion depth, or catheter has pulled partially or completely out
• Skin integrity compromise so severe that dressing cannot be secured (involves wound care and provider collaboration)

Dressing selection: transparent vs gauze

The default dressing for all central lines is the transparent semipermeable membrane (TSM). Gauze is used only when clinical conditions prevent TSM from functioning correctly.

When gauze is used, change it every 2 days (CDC 2011; SHEA 2022), and sooner if it becomes damp, soiled, or loose. Gauze hides the site from view, so the 7-day transparent-dressing interval does not apply to it. CDC 2011 recommends gauze while the patient is diaphoretic or the site is bleeding or oozing.

Transition from gauze to TSM as soon as the site condition allows.

Securement device options

Catheter securement prevents migration, accidental dislodgement, and the repetitive in-and-out catheter movement that damages vessel endothelium and increases infection risk.

StatLock and other sutureless stabilization devices CDC 2011 recommends a sutureless securement device to reduce infection risk (Category II), and INS standards favor engineered stabilization devices. SHEA 2022 is more cautious: it states that the effect of sutureless securement on CLABSI is unknown. StatLock uses a skin-adhesive pad with a clip that holds the catheter hub without sutures or tape. It is applied under or adjacent to the transparent dressing and replaced per the manufacturer’s instructions, usually with the dressing.

Sutures Sutures placed at insertion were the historical standard. They remain in use for some non-tunneled CVCs in procedural settings. Sutures hold the catheter in place, but they create additional skin punctures that can become colonized and carry a needlestick risk for the clinician, which is part of why CDC 2011 favors sutureless securement.

Tape alone Not recommended as the primary securement method for a central line. Tape loosens with moisture and time and does little to stop catheter movement.

Frequency summary

Documentation requirements

After every dressing change, document the following in the patient’s medical record:

• Date and time of dressing change
• Dressing type applied (TSM or gauze)
• CHG disc applied: yes or no
• External catheter length at time of change, compared to documented baseline
• Insertion site appearance: intact skin or specific findings (erythema, swelling, drainage – describe character and extent)
• Presence or absence of sutures/securement device and their integrity
• Catheter stabilization device replaced: yes or no
• Any provider notification: reason for notification and provider response
• Patient tolerance of procedure

Patient education

Most patients do not know what a central line dressing change involves. Clear education reduces anxiety, improves cooperation during the procedure, and reduces complication risk in patients discharged with lines in place.

What to tell the patient before the procedure:

• The dressing change takes about 10–15 minutes
• You need to hold still – especially when the dressing is being removed and the site is being cleaned
• The cleaning solution may feel cold. Chlorhexidine must be kept out of the eyes, ears, and mouth, so keep your face turned away from the insertion site
• The patient should not speak or cough toward the site during the procedure – turning the face away or wearing a mask during the change is for the patient’s protection

For patients going home with a central line (tunneled catheter or port):

• Inspect the dressing every day. Call the care team if the dressing is wet, lifted, soiled, or falls off
• Do not get the dressing wet – cover it when showering
• Do not attempt to change the dressing without proper training and the correct supplies
• Know the signs of infection to report: new redness around the site, swelling, discharge, fever above 38°C (100.4°F), chills

NCLEX high-yield points

These are the highest-yield, most commonly tested central line dressing change points on NCLEX.

• Sterile technique throughout. Central line dressing changes are sterile procedures, not clean procedures. The nurse wears sterile gloves for site cleansing and dressing application. Non-sterile gloves are used only for dressing removal.
• Masks for the procedure. Most protocols have the nurse wear a mask, and the patient either turns their face away or also wears one. In NCLEX review materials, donning a mask before opening the dressing kit is part of the expected answer.
• Remove the old dressing toward the insertion site, not away from it. Peeling away from the site applies outward traction to the catheter. This is tested as a discrimination between correct and incorrect technique.
• Let the CHG dry completely before dressing the site. For ChloraPrep that is about 30 seconds on a dry site after a 30-second scrub, and about 1 minute on a moist site such as the groin after a 2-minute scrub. On NCLEX, applying the dressing immediately after CHG application is an error in technique.
• TSM at least every 7 days; gauze every 2 days. This distinction is directly tested (CDC 2011; SHEA 2022). Leaving a gauze dressing in place for 7 days is a practice error.
• Change any dressing immediately if compromised. The scheduled interval is a maximum, not an absolute. A wet, loose, or soiled dressing needs changing now – not at the next scheduled date.
• CHG disc goes under the transparent dressing, antimicrobial side against the skin. For Biopatch, the white side touches the skin and the printed blue side faces up. A disc placed upside down keeps the chlorhexidine off the skin.
• Apply the transparent dressing from center outward with no tension. Air pockets under the dressing and lifted edges both break the infection barrier. No-tension application prevents the wrinkling and lifting that creates these gaps.
• Measure and document external catheter length at every dressing change. Report any change from baseline to the provider before the PICC or CVC is used again; there is no validated cutoff below which a change is safe to ignore.
• Purulent drainage = notify provider immediately. Purulence at a central line site is an exit-site infection (IDSA 2009) and raises concern for a bloodstream infection. Anticipate paired blood cultures, one from the catheter and one from a peripheral vein, drawn before antibiotics.
• Use a stabilization device for catheter securement. StatLock or equivalent; tape alone is not recommended as primary securement (CDC 2011 favors sutureless securement devices).
• Femoral sites are avoided where a reasonable alternative exists. CDC 2011 still advises avoiding the femoral vein for adult central venous access, and SHEA 2022 names the subclavian vein as the preferred site in the ICU. The evidence on femoral infection risk is more mixed than older teaching suggests. In the 3SITES trial, the combined rate of bloodstream infection and symptomatic DVT was higher for femoral and jugular lines than for subclavian lines, with femoral and jugular similar to each other (Parienti 2015). A meta-analysis found no significant difference in bloodstream infection between femoral and subclavian sites (Marik 2012), and a 2025 retrospective analysis of 65,265 matched patients found femoral lines were not significantly riskier than either other site, while jugular lines carried a significantly higher risk than subclavian (Vaughan-Masamitsu 2025). For the dressing change itself, sterile technique is the same at every site; the groin is a moist site, so it needs the longer 2-minute CHG scrub, and a groin dressing is harder to keep intact.

Related skills

Central line dressing changes connect to several adjacent clinical skills:

• Central line nursing overview – CVC types, insertion, hemodynamic monitoring, air embolism management, and removal
• PICC line nursing – placement, tip verification, power-injectable PICCs, and PICC removal
• PICC line care – day-to-day PICC maintenance including the SASH flushing protocol, blood draws, and occlusion troubleshooting
• Infection control and isolation precautions – the complete CLABSI prevention bundle, standard precautions, and sterile field principles
• Blood culture collection nursing – how to draw blood cultures from a central line and a peripheral site when CLABSI is suspected

References

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