Central Line & PICC Dressing Change: Step-by-Step Procedure

Step-by-step sterile procedure for changing a central venous catheter or PICC dressing: frequency, CHG antisepsis, transparent vs gauze dressings, securement, MARSI prevention, and documentation.

Guide For clinicians
By Dennis Woo, Dr. Mike Stern & I.M. Wright 2 min read

Central Line & PICC Dressing Change: Step-by-Step Procedure

The dressing change is the single most frequent CLABSI maintenance task — performed dozens of times over a catheter’s dwell — and one of the most common points where technique drifts. A clean, intact, well-secured dressing protects the exit site; a sloppy change introduces infection and risks dislodgement and skin injury. This is the step-by-step sterile procedure for PICCs and central venous catheters.

Parent reference: Vascular Access Fundamentals · CLABSI Prevention

When to Change the Dressing

Dressing typeRoutine frequency
Transparent semipermeable (TSM)At least every 7 days
Gauze, or TSM over gauzeEvery 2 days
Any dressingImmediately if loose, lifted, damp, soiled, or contaminated

Supplies

Sterile dressing-change kit (sterile field, drape), 2% CHG in 70% alcohol, CHG-impregnated dressing or disc, engineered/sutureless securement device, skin protectant/barrier film, mask(s), sterile gloves, new transparent dressing, and a label.

The Procedure

  1. Confirm a change is due; explain to the patient.
  2. Hand hygiene, mask, open sterile field.
  3. Remove the old dressing distal-to-proximal, peel low and slow; stabilize the catheter.
  4. Assess the site and external catheter length; hand hygiene.
  5. Sterile gloves; antisepsis — CHG/alcohol, 30-second friction, full dry time.
  6. Securement + CHG disc + transparent dressing, applied without tension.
  7. Label and document.

MARSI is common and underreported. Reduce it by using a skin barrier/protectant film, removing dressings with the “peel low and slow” technique parallel to the skin, avoiding tension or stretching of the dressing, and selecting gentler adhesives for fragile skin. See Catheter Complications for skin-injury management.

Special Situations

  • Oozing/bleeding site (new insertion): a gauze dressing changed every 2 days is appropriate until oozing stops, then switch to TSM.
  • Diaphoresis or skin not intact: gauze may be required; address the underlying cause.
  • CHG allergy: use povidone-iodine or alcohol per policy; document the contraindication.

References

  1. Gorski LA, et al. (2021). Infusion Therapy Standards of Practice (8th ed.). Journal of Infusion Nursing, 44(Suppl 1), S1–S224.
  2. O’Grady NP, et al. (2011). Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), e162–e193.
  3. Marschall J, et al. (2014). Strategies to prevent CLABSI in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(7), 753–771.
  4. McNichol L, et al. (2013). Medical adhesives and patient safety: MARSI consensus statement. Journal of Wound, Ostomy and Continence Nursing, 40(4), 365–380.

Frequently asked questions

How often should a PICC or central line dressing be changed?
A transparent semipermeable dressing is changed at least every 7 days; a gauze dressing (or transparent dressing with gauze under it) is changed every 2 days. Any dressing is changed immediately whenever it becomes loose, lifted, damp, soiled, or visibly contaminated, regardless of how recently it was placed.
What antiseptic is used for a central line dressing change?
The preferred skin antiseptic is 2% chlorhexidine gluconate in 70% alcohol, applied with back-and-forth friction for 30 seconds and allowed to dry completely. A chlorhexidine-impregnated dressing or disc at the exit site is also recommended to reduce CLABSI risk in patients over 2 months of age.
How do you remove a dressing without pulling out the catheter?
Stabilize the catheter with one hand and remove the dressing from the periphery toward the insertion site (distal to proximal), peeling it low and slow, parallel to the skin rather than upward. This ‘peel low and slow’ technique prevents both catheter dislodgement and medical adhesive-related skin injury (MARSI).
Is a central line dressing change sterile or clean?
It is a sterile procedure performed with aseptic non-touch technique: hand hygiene, a mask, a sterile field, sterile gloves, CHG antisepsis with full dry time, and a sterile dressing. This is a core element of the CLABSI maintenance bundle.