Vascular Access Device Post-Insertion Care
Establishes standards for post-insertion care of all vascular access devices, including systematic assessment protocols, dressing selection and change intervals, skin antisepsis, site protection, infection prevention strategies, documentation requirements, and population-specific considerations.
Vascular Access Device Post-Insertion Care Policy
1. Policy Statement
All vascular access devices (VADs) in use at this institution require systematic post-insertion care encompassing routine assessment, dressing management, skin antisepsis, infection prevention, and documentation performed in accordance with evidence-based standards. Clinical teams are responsible for conducting daily necessity reviews to ensure continued VAD use remains clinically justified, and for removing devices promptly when they are no longer required or when complications cannot be resolved. All site care and dressing changes must be performed using Aseptic Non-Touch Technique (ANTT).
2. Purpose
The purpose of this policy is to:
2.1 Establish minimum standards for the routine assessment and monitoring of all peripheral and central VADs across all care settings.
2.2 Define dressing types, selection criteria, and replacement intervals for VADs in standard, neonatal, pediatric, and high-acuity populations.
2.3 Standardize skin preparation and skin protection practices during dressing changes to preserve site integrity and minimize infection risk.
2.4 Delineate securement, labeling, and activity restriction requirements to prevent catheter dislodgement and protect access sites.
2.5 Specify infection prevention strategies, including chlorhexidine gluconate (CHG) bathing and CHG-containing dressing use, to reduce catheter-associated bloodstream infection.
2.6 Define documentation and patient education requirements for VAD post-insertion care.
3. Scope
This policy applies to:
3.1 All clinical personnel authorized to assess, care for, or manage VADs, including registered nurses, advanced practice providers, vascular access specialists, and physicians.
3.2 All VAD types: peripheral intravenous catheters (PIVCs), midline catheters, peripherally inserted central catheters (PICCs), non-tunneled central venous access devices (CVADs), tunneled cuffed CVADs, implanted ports, peripheral arterial lines, and intraosseous access devices.
3.3 All care settings in which VADs are used: inpatient units, intensive care, perioperative services, emergency department, ambulatory infusion, long-term care, and home care operating under organizational oversight.
4. Policy Requirements
4.1 Foundational Care Standards
4.1.1 Complete Infusion System Assessment
4.1.1.1 The complete infusion system—from the VAD insertion site through all connections and administration set components to the solution container—requires routine assessment. This assessment must include verification of system integrity, confirmation of infusion accuracy, identification of early complications, and monitoring of expiration dates for all infusates, dressings, and administration sets.
4.1.2 VAD Necessity Review
4.1.2.1 The continuing need for each VAD must be discussed with the healthcare team on a daily basis. Devices must be promptly removed when complications arise that cannot be resolved, when the clinical indication has resolved, or when the VAD is no longer required for the patient’s plan of care.
4.1.3 Sterile Dressing Requirement
4.1.3.1 All peripheral and central VADs must be covered by a sterile dressing at all times. The dressing may be combined with or integrated into a securement device. Dressings serve three functions: site protection, microbial barrier maintenance, and promotion of skin health in conjunction with catheter securement.
4.1.4 ANTT Requirement
4.1.4.1 All site care and dressing changes must adhere to ANTT. Clinicians must apply Standard-ANTT or Surgical-ANTT based on their individualized assessment of procedural risk and their ability to prevent contact with Key-Sites and Key-Parts throughout the procedure.
4.2 Care Bundle Implementation
4.2.1 Post-Insertion Care Bundle
4.2.1.1 All facilities must implement a comprehensive post-insertion VAD care bundle as part of an organizational safety culture framework. Consistently applied bundled approaches have demonstrated significant reductions in catheter-related infections and must not be selectively applied.12
4.3 Assessment Protocols
4.3.1 Daily Necessity Review
4.3.1.1 A formal review of each VAD’s continued clinical necessity must be conducted daily as part of structured interprofessional patient care discussions. The outcome of the necessity review must be documented in the patient record.
4.3.2 Comprehensive System Inspection
4.3.2.1 A comprehensive inspection of the infusion system must be performed with each infusion intervention, proceeding visually from the solution container through all administration set components to the insertion site.
4.3.3 Patency Assessment
4.3.3.1 VAD patency must be verified through appropriate flushing protocols at defined assessment intervals and before and after each infusion, medication administration, or blood sampling procedure.
4.3.4 Site and Surrounding Tissue Evaluation
4.3.4.1 Assessment of the VAD site and surrounding tissue must include palpation and visual inspection of the insertion site, surrounding skin, and catheter pathway. The following must be evaluated and documented: skin integrity; dressing condition; securement device function; evidence of catheter malposition or migration; erythema; tenderness; swelling; infiltration or extravasation; induration; elevated local skin temperature; and presence or character of drainage.
4.3.4.2 Patient-reported symptoms including pain, paresthesia, numbness, and tingling are critical subjective assessment data and must be solicited at each assessment encounter.
4.3.4.3 When localized tenderness or indicators of possible local infection are present, nontransparent dressings must be removed to permit direct visual inspection of the insertion site. In the absence of such indicators, palpation through an intact dressing is acceptable.
4.3.5 External Catheter Length Measurement
4.3.5.1 External catheter length must be measured at each dressing change and whenever catheter malposition is suspected. The measured length must be compared to the documented length recorded at insertion to detect tip migration.
4.3.6 Extremity Circumference Measurement
4.3.6.1 Baseline extremity circumference must be documented at the time of insertion for all midline catheters and PICCs. Subsequent measurements must be obtained when clinically indicated (e.g., new or worsening edema) to identify findings consistent with catheter-associated deep vein thrombosis (CA-DVT).
4.4 Assessment Frequency
4.4.1 Central Venous Access Devices — Inpatient and Nursing Facility
4.4.1.1 CVADs must be assessed with each infusion intervention and at a minimum of once per shift (or once daily per facility policy), whichever is more frequent.
4.4.2 Peripheral Intravenous Catheters — Inpatient and Nursing Facility
Table 1: PIVC Assessment Frequency — Inpatient and Nursing Facility
| Patient Population | Minimum Assessment Frequency |
|---|---|
| Standard adult | Every 4 hours |
| Critically ill or sedated | Every 1–2 hours |
| Cognitive deficit | Every 1–2 hours |
| Neonatal/Pediatric | Hourly |
| Receiving vesicant medications | More frequent than standard adult; per infusion and vesicant protocol |
4.4.3 Outpatient and Home Care Settings
4.4.3.1 All VADs must be assessed at every clinical visit in outpatient and home care settings.
4.4.3.2 Patients and caregivers must be educated to assess the VAD site with each infusion or at a minimum once daily.
4.4.3.3 Patients with continuous PIVCs in outpatient or home care settings must assess the site every 4 hours during waking hours.
4.4.3.4 Patients and caregivers must receive explicit instruction on when and how to report complications or evidence of dressing integrity compromise to their healthcare provider.
4.4.4 Securement and Adhesive Securement Systems
4.4.4.1 Securement devices designed to remain in place for the life of the VAD (adhesive stabilization/securement systems, SASS) must have their integrity assessed at each dressing change.
4.5 Dressing Management
4.5.1 Transparent Semi-Permeable Membrane Dressings
4.5.1.1 TSM dressings must be changed at a minimum every 7 days under standard conditions, unless contraindicated by patient population (see Section 4.5.1.2) or clinical circumstances warrant earlier change.
4.5.1.2 TSM dressings applied to neonatal patients must be changed based on clinical indication only. Fixed-interval changes are contraindicated in neonates. Indications for dressing change include visible soiling, dampness, or loosening. Clinically driven change intervals minimize risk of catheter dislodgement, patient discomfort, and neonatal skin injury.
4.5.1.3 TSM dressings must be changed immediately whenever any of the following conditions are identified: lifting or detachment at any border edge; visible soiling beneath or around the dressing; moisture, drainage, or blood visible under the transparent portion; or compromised skin integrity beneath the dressing.
4.5.2 Gauze Dressings
4.5.2.1 Gauze dressings must be changed every 2 days or sooner if damp, loose, or visibly soiled.
4.5.2.2 When gauze is placed under a TSM dressing for any reason (e.g., absorption of drainage, support of catheter wings), the entire combined dressing assembly must be treated as a gauze dressing and changed every 2 days accordingly.
4.5.2.3 The exception to Section 4.5.2.2 applies when gauze is used solely to support the wings of an implanted port needle without obscuring the insertion site; in this circumstance, the TSM component governs the change interval.
Table 2: Dressing Change Intervals
| Dressing Type | Standard Change Interval | Exceptions / Immediate Change Criteria |
|---|---|---|
| TSM | Every 7 days | Immediately if integrity compromised (lifting, soiling, moisture, drainage, skin compromise) |
| TSM — Neonatal | As clinically indicated (no fixed interval) | Soiling, dampness, loosening |
| Gauze | Every 2 days | Earlier if damp, loose, or visibly soiled |
| Gauze under TSM | Every 2 days (treated as gauze dressing) | Earlier if damp, loose, or soiled |
4.5.3 Dressing Change Procedure
4.5.3.1 All dressing changes must be performed using Standard-ANTT or Surgical-ANTT based on procedural risk assessment. Surgical-ANTT is required whenever the insertion site cannot be reliably protected from contact without sterile field establishment.
4.5.3.2 Standardized dressing change kits must be used when available. Standardization improves procedural consistency and reduces omission risk.
4.6 Skin Preparation and Protection
4.6.1 Dressing and Securement Removal
4.6.1.1 Dressing and securement device removal must not be performed by rapid peeling or vertical pulling. Adequate skin support must be provided throughout removal to prevent skin stripping or tearing.
4.6.1.2 Sterile gloves must be worn if contact with the insertion site (Key-Site per ANTT framework) is anticipated or occurs during dressing removal.
4.6.2 Hair Removal
4.6.2.1 When hair removal is required at or near the VAD site, single-patient-use scissors or disposable-head surgical clippers must be used.
4.6.2.2 Shaving of VAD sites is strictly contraindicated. Shaving creates microscopic skin trauma that increases infection risk at the catheter insertion site.
4.6.3 Skin Antisepsis
4.6.3.1 All antiseptic solutions applied during dressing changes must be allowed to dry completely per the manufacturer’s instructions before dressing application. Dressings must not be applied to wet antiseptic.
4.6.4 Antimicrobial Ointment
4.6.4.1 Antimicrobial ointment must not be applied to VAD insertion sites as a component of routine care. The sole exception is hemodialysis catheter exit sites, which are governed by specific hemodialysis catheter care protocols.
4.6.5 Tissue Adhesive
4.6.5.1 Tissue adhesive applied at the VAD insertion site may be used to decrease the frequency of dressing changes and improve catheter survivability. Tissue adhesive provides a hemostatic effect that reduces insertion site bleeding and improves dressing adherence at the securement margin.
4.6.6 Enhanced Adhesive Solutions
4.6.6.1 For adult patients in whom diaphoresis or other factors impair standard dressing adherence, gum mastic liquid adhesive may be applied to improve adherence.
4.6.6.2 A skin barrier film must be applied to the skin prior to gum mastic adhesive application to protect the epidermis.
4.6.6.3 Correct dressing removal technique must be employed at all times when enhanced adhesives are in use to prevent catheter-associated skin injury (CASI).
4.7 Dressing Selection Criteria
4.7.1 Selection Factors
4.7.1.1 Dressing selection must be individualized based on the following factors: VAD type and access site characteristics; patient bleeding risk and infection risk; skin condition, integrity, and history of allergic or sensitivity reactions; patient size and body habitus; patient preference when clinically feasible; cost; sterility requirements; expected wear time; and ease of application and removal. The overarching goal is to minimize the frequency of dressing disruption, as each unnecessary change introduces infection risk.
4.7.2 TSM Dressing Preference
4.7.2.1 TSM dressings are associated with longer device dwell times and fewer catheter failures compared to gauze dressings and are the preferred dressing type when site conditions permit.
4.7.3 Gauze and Absorbent Dressing Indications
4.7.3.1 Gauze or sterile absorbent dressings are indicated in the presence of active drainage from the catheter exit site (unless a hemostatic agent has been applied) or when diaphoresis precludes reliable adherence of TSM dressings.
4.7.4 CHG-Containing Dressings
4.7.4.1 Chlorhexidine gluconate (CHG)-containing dressings are required for all short-term CVADs in patients older than 2 months unless contraindicated by known sensitivity or allergy to chlorhexidine.23 Any documented sensitivity or allergy to CHG must be recorded prior to dressing selection.
4.7.5 Tunneled Cuffed CVADs
4.7.5.1 Once the subcutaneous tunnel of a tunneled cuffed CVAD has fully healed, a covering dressing may no longer be required. Tunnel healing typically occurs within approximately 3 weeks post-insertion. The determination that a dressing is no longer required must be made by the responsible clinical team and documented.
4.8 Securement and Site Protection
4.8.1 VAD Securement
4.8.1.1 An appropriate securement method must be used to stabilize all VADs. A bundled approach to securement (combining securement device, dressing, and additional stabilization as indicated) frequently provides optimal outcomes for catheter stability and longevity.
4.8.2 Additional Site Protection
4.8.2.1 When risk of catheter dislodgement is elevated or when the catheter crosses a flexion point, additional site protection strategies must be employed to provide joint stabilization.
4.8.3 Dressing Labels
4.8.3.1 All dressing labels must indicate either the date the dressing was applied or the date the next scheduled dressing change is due per organizational policy. Labels must never be placed in a location that covers the insertion or exit site.
4.8.4 Prohibited Securement Materials
4.8.4.1 Rolled bandages, whether elastic or non-elastic, must not be used as a primary securement method or as primary site protection for any VAD.
4.8.4.2 When additional site coverage is clinically required, a single tubular sleeve that permits easy removal for site inspection is the preferred approach.
4.8.5 Supplemental Tape
4.8.5.1 Any supplemental tape used at or near a VAD site must be sterile and dedicated to single-patient use. Tape selection must account for the intended use and the patient’s current skin condition.
4.9 Catheter Protection During Daily Activities
4.9.1 Sharp Objects
4.9.1.1 Sharp objects, including scissors, hemostats, and pins, must be kept away from all VADs at all times. Sharp instruments must never be used on or near a catheter.
4.9.2 Bathing and Showering
4.9.2.1 The entire catheter dressing site must be protected during bathing or showering using clear plastic wrap or a commercially available protective device. All catheter connections must be covered, and hub connections must be protected from water contamination.
4.9.3 Blood Pressure Cuffs and Tourniquets
4.9.3.1 Blood pressure cuffs must not be applied over a VAD dressing site or over the upper extremity containing a PICC.
4.9.3.2 Tourniquets must not be applied to any extremity containing a peripheral VAD (including midline catheters) during active infusion periods.
4.10 Infection Prevention
4.10.1 Chlorhexidine Bathing
4.10.1.1 Chlorhexidine gluconate (CHG) bathing must be incorporated into care protocols for patients with CVADs to minimize the risk of central line-associated bloodstream infection (CLABSI).123 Manufacturer instructions must be consulted regarding potential effects of CHG bath products on dressing integrity.
4.10.2 Dressing Integrity
4.10.2.1 Maintaining dressing integrity is a critical infection prevention measure. Dressing disruption—from any cause, including patient activity, moisture accumulation, or incomplete adhesion—is a major modifiable risk factor for catheter-related infections.12 Immediate dressing change is required whenever integrity is compromised.
4.11 Special Population Considerations
4.11.1 Neonates
4.11.1.1 The fragility of neonatal skin requires careful selection of adhesive products and meticulous removal technique for all dressings and securement devices. Dressing changes must be clinically indicated; scheduled dressing changes are contraindicated in neonates.
4.11.1.2 The smaller patient size in neonates increases the technical complexity of securement and amplifies the clinical consequences of catheter dislodgement, requiring heightened vigilance and specialized securement strategies.
4.11.2 Pediatric Patients
4.11.2.1 PIVC sites in pediatric patients must be assessed hourly. Securement must be age-appropriate, accounting for developmental stage, activity level, and cooperation capacity.
4.11.2.2 Developmental considerations must inform dislodgement prevention strategies. Child life specialists or family involvement may be incorporated to optimize adherence to site protection measures.
4.11.3 Critically Ill and Sedated Patients
4.11.3.1 Critically ill and sedated patients are unable to report subjective symptoms. PIVC sites must be assessed every 1 to 2 hours in this population.
4.11.3.2 Critically ill patients may present with altered skin integrity, coagulopathy, or immune compromise that requires individualized dressing selection and enhanced attention to skin protection during dressing changes.
4.11.4 Patients with Cognitive Deficit
4.11.4.1 Patients with cognitive deficits require enhanced monitoring frequency and supplemental site protection measures consistent with Table 1 (every 1 to 2 hours for PIVCs) and Section 4.8 requirements.
4.12 Documentation Requirements
4.12.1 The following must be documented in the patient’s health record:
4.12.1.1 External catheter length at insertion and at each subsequent dressing change.
4.12.1.2 Baseline extremity circumference at insertion and subsequent measurements for all midline catheters and PICCs.
4.12.1.3 Date and time of each dressing change, including the condition of the site and dressing at the time of change.
4.12.1.4 Findings from each site assessment, including objective signs and patient-reported symptoms.
4.12.1.5 Daily VAD necessity review outcomes.
4.12.1.6 Any complications identified and interventions performed.
4.13 Patient and Caregiver Education
4.13.1 Outpatient and Home Care Education Requirements
4.13.1.1 All patients and designated caregivers managing VADs in outpatient or home care settings must receive structured education prior to discharge or initiation of home care. Education must include:
4.13.1.2 Technique for visual inspection of the VAD site for redness, swelling, warmth, drainage, or dressing compromise.
4.13.1.3 Required frequency of site assessment based on device type and infusion schedule.
4.13.1.4 Symptoms requiring immediate reporting to a healthcare provider: pain, numbness, tingling, fever, shaking chills, or visible signs of infection.
4.13.1.5 Instructions for dressing protection during bathing and personal hygiene activities.
4.13.1.6 Activity modifications to prevent catheter dislodgement or damage.
4.13.1.7 Contact information and procedures for reaching the healthcare team after hours.
4.13.1.8 Demonstration of return demonstration competency must be documented for any patient or caregiver performing VAD self-care.
5. Compliance
5.1 Key Performance Indicators
5.1.1 CLABSI rate per 1,000 central line days, monitored monthly and benchmarked against National Healthcare Safety Network (NHSN) standards.
5.1.2 Percentage of CVADs with documented daily necessity review per audit cycle.
5.1.3 Dressing change compliance rate (correct interval and technique) assessed via direct observation.
5.1.4 Percentage of CVADs in patients over 2 months of age with documented CHG-containing dressings or documented contraindication.
5.1.5 Rate of unplanned VAD removals attributable to dressing failure or site complications.
5.1.6 Percentage of clinical staff completing post-insertion VAD care competency assessment annually.
5.1.7 Patient and caregiver education documentation rate for outpatient and home care VAD patients.
5.1.8 PIVC assessment frequency compliance rate by patient population category.
5.2 Enforcement
5.2.1 Adherence to this policy is a professional responsibility of all clinical personnel involved in VAD management.
5.2.2 Individual non-compliance will be addressed through applicable unit-based coaching and performance management processes with escalation to clinical leadership as warranted.
5.2.3 Patterns of unit-level non-compliance will trigger targeted education, direct observation audits, and a re-audit within 30 days of intervention.
5.2.4 Patient harm events attributable to lapses in post-insertion VAD care must be reported through the organizational event reporting system and reviewed by the Vascular Access Governance Committee and Infection Prevention.
6. Exceptions
6.1 Clinical judgment may necessitate modification of dressing change intervals (earlier than scheduled) in response to patient-specific factors including skin fragility, wound healing complications, or unusual exposure conditions. Early dressing changes for clinical indication require no exception approval.
6.2 Emergent clinical situations may temporarily preclude the performance of dressing changes at prescribed intervals. When a scheduled dressing change is delayed for clinical reasons, the reason must be documented and the change must be performed at the earliest safe opportunity.
6.3 Patients with documented CHG sensitivity or allergy are exempt from the CHG-containing dressing requirement. The contraindication and alternative dressing selected must be documented in the patient record.
6.4 Tunneled cuffed CVADs in patients whose subcutaneous tunnel has healed are exempt from the dressing requirement per Section 4.7.5. The clinical determination that the tunnel is healed must be documented by the responsible clinician.
6.5 Clinical research protocols approved by the Institutional Review Board (IRB) may modify assessment or dressing change intervals per approved protocol specifications, with contemporaneous documentation.
7. Related Documents
- ANTT Policy
- Administration Set Management Policy
- Vascular Access Device Flushing and Locking Policy
- Vascular Access Device Selection and Insertion Policy
- CLABSI Prevention Bundle
- Needleless Connector Management Policy
- Hand Hygiene Policy
- Standard Precautions Policy
- Chlorhexidine Bathing Protocol
- Hemodialysis Catheter Care Policy
- Vascular Access Device Adverse Event Management and Reporting Policy
- Parenteral Nutrition Administration Policy
- Patient and Caregiver Education — VAD Home Care Guide
8. Revision History
| Version | Date | Author | Description |
|---|---|---|---|
| 1.0 | 2024-08-01 | Vascular Access Governance Committee | Initial policy |
| 1.1 | 2025-11-30 | Vascular Access Governance Committee | Added structured assessment frequency tables; clarified CHG dressing requirement threshold (patients >2 months); expanded special population requirements for critically ill and cognitively impaired; added enhanced adhesive and tissue adhesive guidance; updated documentation requirements |
References
Rupp ME, Majorant D. Prevention of vascular catheter-related bloodstream infections. Infect Dis Clin North Am. 2016;30(4):853-868. doi:10.1016/j.idc.2016.06.001 ↩︎ ↩︎ ↩︎
Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022;43(5):553-569. doi:10.1017/ice.2022.87 ↩︎ ↩︎ ↩︎ ↩︎
Martillo M, Zarbiv S, Gupta R, et al. A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices. Am J Infect Control. 2020;48(4):460-464. doi:10.1016/j.ajic.2019.09.021 ↩︎ ↩︎
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