Central Line Care and CLABSI on the NCLEX
CLABSI bundle elements, dressing changes, scrub the hub, and air embolism positioning.
CLABSI is a never event. The bundle is testable line by line.
The bundle
Insertion: hand hygiene, maximal barrier precautions (sterile gown, gloves, cap, mask, full-body drape), chlorhexidine skin prep, and site selection that avoids the femoral vein in adults. Maintenance: daily review of line necessity; pull the line the day it stops earning its place. Scrub the hub with alcohol for at least 15 seconds before every access. Keep the system closed; change caps per policy.
Dressing changes
Transparent semipermeable dressing: change every 7 days and immediately if damp, loose, or soiled. Gauze dressing: every 48 hours. Sterile technique with a mask on you, face turned or masked for the patient. Chlorhexidine prep with friction; let it dry completely before the new dressing. Document the date. A lifted edge is not cosmetic: it is a portal.
Air embolism
Risk moments: tubing changes, cap changes, line removal, any open hub. Prevention: clamp when open to air, use Luer-lock connections, remove the line with the patient supine, performing Valsalva or exhaling, then seal the site with petroleum-based gauze and an occlusive dressing. If air embolism is suspected (sudden dyspnea, chest pain, hypotension, sense of doom): clamp the line and position the patient on the left side in Trendelenburg to trap air in the right ventricle away from the pulmonary outflow tract. Give 100% oxygen and call for help.
Signs of line infection
Fever or chills without another source, redness, drainage, or tenderness at the site. Do not culture through and keep using a line you suspect. Report it; blood cultures are typically drawn from the line and a peripheral site to compare.
Frequently asked
How long do you scrub the hub?
At least 15 seconds with friction using alcohol, before every single access. Let it dry.
Patient position for CVC removal?
Supine (or slight Trendelenburg), patient performing Valsalva or exhaling as the line comes out. Occlusive petroleum gauze immediately after.
Transparent dressing due but intact at day 5?
Leave it until day 7 unless damp, loose, or soiled. Extra changes increase entry opportunities.
Quick check
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