Discharge Instructions: Changing the Dressing on Your Peripherally Inserted  Catheter (Midline)

Date catheter was placed:  ______________

Date catheter will be removed: _____________

You are going home with a peripherally inserted catheter (midline). This small, soft tube has been placed in a vein in your arm. Where the catheter enters your body, it’s covered with a bandage (dressing). The bandage is often made of clear (transparent) plastic. This helps keep the area free of germs. To prevent infection, you need to keep the dressing clean and dry. Only change the dressing if you or a caregiver have been told to do so. This sheet explains the process. Also follow any specific instructions you get from your healthcare provider.

Prevent infection with good hand hygiene

A midline can let germs into your body. This can lead to serious and sometimes deadly infections. To prevent infection, it’s very important that you, your caregivers, and others around you use good hand hygiene. This means washing your hands well with soap and water, and cleaning them with an alcohol-based hand gel as directed. Never touch the midline or dressing without first using one of these methods.

To wash your hands with soap and water:

• Wet your hands with warm water (Avoid hot water. It can cause skin irritation when you wash your hands often.)

• Apply enough soap to cover the whole surface of your hands, including your fingers

• Rub your hands together vigorously for at least 15 seconds. Make sure to rub the front and back of each hand up to the wrist, your fingers and fingernails, between the fingers, and each thumb

• Rinse your hands with warm water

• Dry your hands completely with a new, unused paper towel. Don’t use a cloth towel or other reusable towel. These can harbor germs

• Use the paper towel to turn off the faucet, then throw it away. If you’re in a bathroom, also use a paper towel to open the door instead of touching the handle

When you don’t have access to soap and water: Use an alcohol-based hand gel to clean your hands. The gel should have at least 60% alcohol. Follow the instructions on the package. Your health care team can answer any questions you have about when to use hand gel, or when it’s better to wash with soap and water.

When to change the dressing

• If you have a transparent dressing, change it every 7 days (or more often if instructed)

• If the dressing becomes loose, dirty, or wet, change it right away. Report this to your healthcare provider as soon as possible

Avoiding infection while changing the dressing

The midline provides a direct path into your bloodstream. So the chance of infection is high as you change the dressing. Don’t touch the catheter where it enters the skin. And be very careful to keep your work area and supplies clean. Following the steps on this sheet will help. Keep in mind that some supplies come in germ-free (sterile) packaging. Make sure to keep these sterile during the dressing change.

Supplies for changing the dressing

A general list of supplies is below. Your health care team will provide you with a list of specific items and brands to use. Or you may get a kit that has everything you need. Your supplies may include:

• Gauze dressing

• Transparent dressing

• Antimicrobial sponge disk

• Antiseptic supplies to clean the skin and around the catheter exit site (such as chlorhexidine plus alcohol)

• Sterile gloves

• Non-sterile gloves and a mask

• Medical tape, adhesive strips, or a securement device

Before you start, review the steps below and make sure you understand them. If you’re not sure what to do or how to use your supplies, ask a member of your healthcare team before you try to change the dressing.

Note: Since the midline is in your arm, you’ll only have one free arm during the dressing change. This makes it very hard to change the dressing yourself. Have someone available to help you.

Step 1. Wash your hands

Wash your hands well with soap and water. Use the method described above.

Step 2. Prepare your work area

• Choose an area with a hard, flat surface where you can easily spread out the supplies, such as a desk or table. Don’t use the bathroom; there are too many germs

• Put pets and children out of the work area. Keep them out until the dressing change is done

• Clean washable surfaces with soap and water. Dry with a clean, unused paper towel. Then throw the paper towel away

• Spread clean, unused paper towels over your work surface. Use as many as you need to cover it

• If you need to cough or sneeze, move away from your work surface first

Step 3. Lay out your supplies

• Clean your hands with soap and water or hand gel. Do this before you lay out your supplies on the work surface

• After cleaning your hands, only touch your supplies. If you do touch anything else, such as furniture or your clothes, wash your hands again. This is very important for preventing infection

• Place your supplies on the cleaned and dried work surface. Lay them out in the order you will be using them

• If you’re using a kit with a sterile tray, take off the plastic covering. Remove the covering only. Don’t open the tray. Keep the plastic covering. You can use it to dispose of the old dressing

Step 4. Remove the old dressing

• Put on clean gloves 

• Take off the old dressing by gently pulling the edges. Carefully peel off the dressing in the direction of the catheter site. While doing this, hold the end of the catheter (lumen) so it doesn’t pull out of your body

• If a securement device is in place, carefully remove it using the method your nurse showed you

• Check the catheter site for signs of infection such as redness, swelling, drainage, or a bad odor. If you notice any, call your healthcare team when you’re finished changing the dressing

• Wrap the old dressing in plastic (if available) and put it aside

Step 5. Prepare sterile supplies

• Remove your gloves and clean your hands with hand gel

• Open any sterile supplies, such as the transparent dressing and sterile gloves. Follow the directions on the package or your healthcare team’s instructions

• Put on sterile gloves. Follow the directions on the package or as you were shown in the hospital

Step 6. Clean the catheter site

• If the skin under the dressing has dried blood or a lot of drainage, clean it as directed by your healthcare team

• Clean the catheter exit site using the antiseptic supplies your healthcare team recommends. It’s very important to follow the package directions and your provider’s instructions exactly

Step 7. Apply the new dressing

• If you’re using a securement device, apply it as you were shown

• If you’re using a gauze dressing, apply it over the catheter exit site the way your nurse showed you

• If you’re using an antimicrobial sponge disc, place it around the catheter with the correct side touching your skin. Line up the slit on the sponge disk with the catheter

• Apply the transparent dressing over the catheter exit site and over the gauze or sponge disk (if used). Put the top end down first. Then smooth out the rest across the area where the catheter exits your skin. Make sure the dressing covers the entire catheter

• Take off and discard the sterile gloves

• Tape the end of the catheter (lumen) to your skin, as directed by your healthcare provider

• Throw away the old dressing and used supplies

• Wash your hands

Changing the injection caps

The catheter’s injection caps need to be changed every 3 to 7 days. This is often done at the same time as the dressing change. Your healthcare provider will give you instructions. 

When to seek medical care

Call your healthcare provider right away if you have any of the following:

• Pain or swelling in your arm, shoulder or neck on the side with the catheter

• Bleeding or drainage where the catheter comes out of your arm
• Pain or discomfort when IV fluids are put into your catheter

• Fever of 100.4°F (38.0°C) or higher

• Chills

• Signs of infection at the catheter site (pain, redness, drainage, burning, or stinging)

• Chest pain, shortness of breath or discomfort while your catheter is in place
• If you have a catheter lead or breaks or damages the catheter, fold and tape the catheter between the break or leak and where the catheter come out of your arm
• The catheter falls out, breaks, cracks, leaks, or has other damage
• If you pull the catheter out, immediately push down on the insertion site with a sterile gauze pad and tape it into place