Skin Care Around Your Catheter Site

The skin around your catheter insertion site is the first line of defense against infection — and it is also vulnerable to injury from the adhesives, antiseptics, and repeated dressing changes required to keep the catheter secure and sterile. Healthy skin around the catheter site contributes directly to your safety. This guide explains what can happen to that skin and what you and your care team can do to protect it.

Why Catheter Site Skin Is Vulnerable

Over the course of IV therapy — particularly with central catheters that remain in place for weeks or months — the skin at and around the insertion site is:

Repeatedly cleaned with antiseptics (chlorhexidine, alcohol)
Repeatedly covered and uncovered with adhesive dressings during regular changes
Sealed under an occlusive (airtight) dressing between changes, which can trap moisture
Subjected to adhesive removal forces that can be damaging to fragile or sensitive skin
Exposed to the mechanical presence of the catheter itself exiting through the skin

Certain patients are at higher risk for skin complications:

Older adults (skin becomes thinner, more fragile, less elastic with age)
Patients on long-term corticosteroids (thins the skin)
Patients with underlying skin conditions (eczema, psoriasis)
Patients who have received radiation therapy to the area
Patients with edema (swollen skin is more fragile)
Patients who are malnourished or dehydrated
Patients with compromised circulation

Types of Skin Reactions at Catheter Sites

Contact dermatitis from adhesives (most common)

Contact dermatitis is an inflammatory skin reaction caused by direct contact with a substance. With IV dressings, the two main causes are:

Irritant contact dermatitis: The skin becomes red, dry, itchy, and sometimes raw or blistered from the repeated mechanical and chemical irritation of adhesive application and removal. This is the most common type and does not require an immune response.

Allergic contact dermatitis: A true immune-mediated allergy to a component of the adhesive, antiseptic, or dressing material. This tends to appear with a defined outline corresponding exactly to where the product was applied and may worsen with repeated exposure.

Signs of contact dermatitis:

Redness confined to the area under or around the dressing
Itching at the dressing site
Small blisters, oozing, or peeling within the dressing area
Skin appearing red and shiny after dressing removal

MARSI is damage caused specifically by the removal of adhesive products. The adhesive bonds more strongly to the skin than the skin bonds to the tissue beneath it, and removal strips away the outer layers of skin. MARSI can include:

Skin tears — partial or full-thickness tears from aggressive adhesive removal
Tension injuries — skin stretched and blistered from adhesive pulling
Stripping injuries — repeated removal of skin cells with each dressing change

Signs of MARSI:

Skin looking raw, shiny, or “de-skinned” in the area where the dressing was
Skin tears — a flap of skin with a clearly traumatized wound bed beneath
Pain during or after dressing removal

Moisture-associated skin damage (maceration)

When moisture becomes trapped under the dressing — from perspiration, wound drainage, or external water — the skin softens and weakens, eventually breaking down. This is called maceration.

Signs of maceration:

Skin looking white, soft, and waterlogged under the dressing
Skin that easily tears or rubs away
Wrinkled or pruned-looking skin around the exit site

Folliculitis

Bacterial infection of hair follicles, which can occur in areas with hair near the catheter dressing (e.g., the inner arm, the chest). Appears as small red pimple-like bumps under or near the dressing.

Chlorhexidine (CHG) skin reaction

Some patients develop a reaction to chlorhexidine, the antiseptic used routinely for catheter site care. This can range from mild skin redness to a significant allergic reaction. Signs include burning, redness, and rash at the site of CHG application.

Preventing Skin Complications

Choosing the right dressing

Your vascular access nurse selects appropriate dressing products for your skin type. If you have a history of sensitive skin or adhesive reactions, tell your nurse before the first dressing is applied. Options available include:

Standard transparent film dressings (e.g., Tegaderm)
Silicone-based adhesive dressings — gentler on fragile skin; the adhesive bonds to skin differently (does not bond as aggressively) and removes more gently
Hydrocolloid borders — for patients with extremely fragile skin
Non-adhesive securement devices — secure the catheter without adhesive contact with the skin

Safe dressing removal technique

How the dressing is removed matters as much as what product is used:

Stretch parallel to the skin (zero-degree removal): Rather than pulling the dressing upward away from the skin, stretch it parallel to the skin surface while holding the skin. This reduces the tensile force on the skin.
Lift slowly and steadily: Rapid removal tears skin. Slow, steady tension is less traumatic.
Adhesive remover products: Silicone-based adhesive removers (available as wipes or spray) dissolve the adhesive bond before removal, dramatically reducing skin damage risk. Ask your nurse if these are available.
Never rip: If a dressing seems stuck, apply adhesive remover rather than forcing removal.

Managing moisture

Transparent film dressings should be changed before they accumulate excessive moisture underneath
If your skin perspires heavily, notify your nurse — more frequent dressing changes or modified products may be needed
CHG bathing cloths should be applied and allowed to air-dry before dressing changes

Skin preparation products

Some facilities use a liquid skin barrier wipe (e.g., Cavilon No-Sting Barrier Film) applied to the peri-site skin before the dressing is placed. This provides a protective coating between the skin and the adhesive, reducing both contact dermatitis and MARSI risk. If you have sensitive skin, ask whether this is available.

Rotating the site within safe parameters

While the catheter itself cannot be moved without clinical justification, the exact placement of the securement device and dressing borders can sometimes be slightly varied with each change to avoid repeatedly traumatizing exactly the same skin. Ask your vascular access nurse.

For Patients with Specific High-Risk Skin Conditions

Older adult patients

Alert your care team to any pre-existing skin fragility before the first dressing
Request silicone-based adhesives or adhesive remover as standard practice
Report any skin changes — even minor ones — at each nursing visit; do not wait for the next scheduled dressing change

Patients on corticosteroids

Corticosteroid-thinned skin bruises and tears very easily
Request the gentlest available adhesive products
Extra care during adhesive removal is essential

Patients who have received radiation

Radiation-damaged skin may never fully recover to normal integrity
The radiated area has reduced blood supply and reduced healing capacity
Avoid placing IV dressings over irradiated skin when at all possible; discuss with your care team

Patients with eczema or psoriasis

Avoid placing dressings over active eczema or psoriasis plaques
Inform your care team of any flare in advance of a dressing change

What to Do If Skin Problems Develop

Mild redness or irritation at the dressing margins

Report this to your vascular access nurse at the next visit or earlier
Do not apply cream or lotion under the dressing — this can compromise adhesion and create a moist, bacteria-friendly environment
Your nurse may switch to a different dressing product

Skin tear or significant skin breakdown

Report immediately — do not wait for the scheduled dressing change
Keep the area clean and covered with a clean cloth if the dressing is off
A skin tear is a wound that requires proper wound care assessment

Suspected contact allergy

Document what product was applied and when the reaction appeared
Report to your care team
If the reaction is severe (widespread redness, blistering, significant pain), this needs prompt assessment
Patch testing (a formal allergy test) may be recommended if reactions recur with multiple products

Persistent or worsening skin breakdown

If skin around the catheter site continues to deteriorate despite product changes, consider wound care specialist consultation
Your care team may involve a wound ostomy continence nurse (WOCN) to assess and recommend specialized products

At Home: What You Can Do

Inspect the dressing and surrounding skin daily. Look for: redness at the dressing edges, any skin peeling or rawness visible at the dressing margins, any moisture visible under the film
Do not apply any products to the skin under or near the dressing unless specifically instructed (no lotion, no cream, no antiseptic)
Keep the dressing dry (use waterproof protection during bathing)
Report changes to your home infusion nurse before the next scheduled dressing change if you see anything concerning

This guide is for educational purposes. Skin care at catheter sites is highly individualized. Always follow the specific guidance of your vascular access nurse, wound care specialist, and care team.