• sterile dressing pack
• sterile swab for culture (only if signs of infection)
• two pairs of sterile gloves
• non sterile gloves
• plastic apron
• chlorhexidine 2% in 70% alcohol sponge applicator
• sterile transparent semi-permeable dressing approx 10cm x 12cm
• disposal bag
• alcohol based hand rub or alternative antiseptic hand hygiene product
• chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipes
• Vygon TKO Needle free device (one per lumen) – Do not use needle free devices with extension sets e.g. vadsite octopus
• 0.9% sodium chloride (10mls per lumen) (10ml PosiFlush XS may be used – ensure the packaging stipulates XS as only these syringes are externally sterile)
• 10iu heparinised 0.9% sodium chloride (2mls per lumen) – only for Hickman or PICC lines with clamps (do not use in central lines)
• 10ml Luer-Lok syringes
• green needles
• antimicrobial chlorhexidine sponge disc dressing
• measuring tape (PICC line only)
• griplock or sterile broad steri-strips (Only if the PICC line does NOT have a SecurAcath insitu)
• Oncology Patients Only: Curos port protector for each lumen (not sterile, therefore do not place this onto the sterile area)

Please note: if your hands are not socially clean and you need to wash your hands with soap and water (rather than alcohol gel), this must be carried out a minimum of 2 meters away from the working surface/dressing trolley and any CVAD equipment.

1. Explain and discuss the procedure with the patient and ensure that the patient understands fully.
2. Clean and dry working surface. Perform hand hygiene as per the WHO 5 moments for hand hygiene. Put on a plastic apron.
3. Open dressing pack onto clean area and open the necessary equipment onto the dressing pack aseptically.
4. Clean hands with alcohol gel as per the WHO 5 moments for hand hygiene and apply non sterile gloves.
5. Remove old dressing from site and antimicrobial disc dressing and dispose of this as per infection control guidelines. Remember that PICC lines need to remain secure during removal of the dressing to prevent migration. Remove non sterile gloves.
6. Clean hands with alcohol gel as per the WHO 5 moments for hand hygiene and apply sterile gloves.
7. A swab for bacteriology should be taken from the exit site if clinical signs of infection are present.
8. Clean the insertion site with chlorhexidine 2% in 70% alcohol sponge applicator using the appropriate technique for 30 seconds and allow to dry completely for a minimum of 30 seconds. For PICC lines with a SecurAcath, gently lift the SecurAcath up and clean under the PICC line taking care not to rotate the SecurAcath.
9. Clean the line from insertion site downwards to the lumen with chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipe and allow to dry completely for a minimum of 30 seconds. Repeat on CVADs with additional lumens.
10. Position antimicrobial chlorhexidine sponge disc dressing (blue side upwards) around the CVAD at exit site (for PICC lines under the SecurAcath). Place a Griplock or steri-strips to secure the PICC line if a SecurAcath is not insitu. Apply sterile transparent semi-permeable dressing over the exit site, touching only the corners, to minimize skin irritation and reduce the risk of the dressing peeling or becoming damaged.
11. Remove PPE and clean hands with alcohol gel as per the WHO 5 moments for hand hygiene. Follow steps 1-10 of the flushing procedure when carrying out 24hour CVAD care post insertion or weekly CVAD care.
12. Dispose of all waste appropriately as per waste management guidelines:
    1. NHS Ayrshire & Arran segregation of waste.
    2. NHS Ayrshire & Arran waste policy.
13. Document procedure, including the length of the line (PICC lines only), any problems and action taken with review date in the CVAD care and mainteance bundle DRS 6104 (appendix 5) and appropriate notes.

Patient Group Directions (PGDs) for CVADs:

HBN 23051: 0.9% sodium chloride (CVADs)

HBN 21224: heparin sodium chloride (CVADs)

PICC line with SecurAcath securement device

Only use the following if a SecurAcath is NOT insitu:

PICC line measurement - where to measure:

If there is any evidence of infection at the exit site advise the patient to contact the local oncology unit or general practitioner for advice. If the patient is an in-patient, inform the medical or surgical team.

If there is any evidence of PICC line migration, refer to appendix 2 of the guideline.

• Never remove sutures from central lines unless the central line is being removed.
• Neck insertion sutures should be removed after 7 days (Hickman lines only)
• Exit site sutures should be removed after 21 days (Hickman lines only)
• Never remove SecurAcath from PICC lines unless the PICC line is being removed.

Suture removal should take place prior to commencing Hickman line care and maintenance.