# N8 — Catheter Care and Infection Bundle

N8 — Catheter Care and Infection Bundle FRONT Front · at the chair

**When:** every catheter connection, disconnection, and dressing change.

### Do this

1.  **Check first:** exit site, tunnel, dressing, and the patient (fever, chills) at every session \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-6)\].
2.  **Masks** for patient and staff; the patient turns the head away and limits talking.
3.  **Hand hygiene, gloves,** and a clean field under the catheter limbs.
4.  **Clamp before opening.** Confirm both limbs are clamped before any cap comes off.
5.  **Scrub the hub** with chlorhexidine (povidone-iodine if intolerant) every time the catheter is accessed or disconnected \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-6)\].
6.  **Aspirate 2–5 mL** of blood and lock from each lumen before connecting, one lumen at a time \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-6)\]. A taurolidine/heparin lock must always be aspirated and discarded \[[7](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-7)\].
7.  **Dressing change:** alcohol-based chlorhexidine (more than 0.5%) on the skin; exit-site ointment per your unit protocol after checking catheter compatibility; change at least weekly and whenever wet or soiled \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-6)\].
8.  **Lock:** saline flush, the prescribed lock at your protocol’s volume, clamp, and a new sterile cap every time.
9.  **Can’t reach the prescribed blood flow?** That is catheter dysfunction: check position, clamps, and flush, then follow the thrombolytic protocol.

### Call the nephrologist when

- **Immediately:** fever, rigors, hypotension, or confusion during or after dialysis. **Obtain ordered blood cultures promptly (catheter hub and dialysis circuit per protocol), before antibiotics when this will not substantially delay urgent treatment** \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-6)\].
- **Same day:** pus or spreading redness at the exit site; tenderness or redness along the tunnel; the cuff is visible or the catheter looks longer.
- **Before the next session:** dysfunction not fixed by bedside maneuvers or one alteplase dwell.
- **Monthly at rounds:** the patient still has a catheter — ask what the permanent-access plan is.

Urgency note: [Surviving Sepsis Campaign guidance](https://pmc.ncbi.nlm.nih.gov/articles/PMC8486643/) supports prompt treatment; collecting cultures must not substantially delay antibiotics in suspected sepsis.

### Don’t

- Don’t leave a lumen open to air — clamp first, cap every time.
- Don’t infuse or flush the lock into the patient; aspirate it.
- Don’t use the catheter for blood draws or medications outside dialysis unless ordered.
- Don’t let culture collection delay emergency sepsis treatment; collect cultures first when feasible without substantial delay \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-6)\].
- Don’t use taurolidine/heparin in a patient with heparin-induced thrombocytopenia or pork allergy \[[7](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-7)\].

N8 — Catheter Care and Infection Bundle BACK Back · why, and the evidence

### Why

1.  Catheter patients have about 8 times the bloodstream infection rate of fistula patients (2.16 vs 0.26 per 100 patient-months) \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-1)\].
2.  Units that implemented the CDC bundle (chlorhexidine, audits, competency, feedback) cut access-related bloodstream infections by 54% \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-2)\].
3.  Chlorhexidine skin antisepsis roughly halved catheter-related bloodstream infection compared with povidone-iodine (RR 0.49) \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-3)\].
4.  A once-weekly alteplase lock cut catheter malfunction from 34.8% to 20.0% and bacteremia from 13.0% to 4.5% over 6 months \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-4)\].
5.  A taurolidine/heparin lock cut catheter-related bloodstream infection from 8.0% to 2.3% (NNT 18) in LOCK IT-100 \[[5](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-5),[7](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html#n8-ref-7)\].

### Go deeper

- Mastery page: [Catheter Care, Lock Solutions, and Bloodstream Infection](https://urinenephrology.org/mastery/maintenance-hd/catheter-care-crbsi.html)
- [All dialysis nursing reference cards](https://urinenephrology.org/mastery/maintenance-hd/nursing/index.html)

### References

1.  Nguyen DB, et al. National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. *Clin J Am Soc Nephrol.* 2017;12:1139-1146. [PubMed 28663227](https://pubmed.ncbi.nlm.nih.gov/28663227/)
2.  Patel PR, et al. Bloodstream infection rates in outpatient hemodialysis facilities participating in a collaborative prevention effort. *Am J Kidney Dis.* 2013;62:322-330. [PubMed 23676763](https://pubmed.ncbi.nlm.nih.gov/23676763/)
3.  Chaiyakunapruk N, et al. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. *Ann Intern Med.* 2002;136:792-801. [PubMed 12044127](https://pubmed.ncbi.nlm.nih.gov/12044127/)
4.  Hemmelgarn BR, et al. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. *N Engl J Med.* 2011;364:303-312. [PubMed 21268722](https://pubmed.ncbi.nlm.nih.gov/21268722/)
5.  Agarwal AK, et al. Taurolidine/heparin lock solution and catheter-related bloodstream infection in hemodialysis (LOCK IT-100). *Clin J Am Soc Nephrol.* 2023;18:1446-1455. [PubMed 37678222](https://pubmed.ncbi.nlm.nih.gov/37678222/)
6.  Lok CE, et al. KDOQI clinical practice guideline for vascular access: 2019 update. *Am J Kidney Dis.* 2020;75(4 Suppl 2):S1-S164. [PubMed 32778223](https://pubmed.ncbi.nlm.nih.gov/32778223/)
7.  DEFENCATH (taurolidine and heparin) catheter lock solution, prescribing information. CorMedix Inc.; DailyMed. [dailymed.nlm.nih.gov](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=13b3a61e-5a4b-4afb-8fa1-d76ebdb344d6&type=display)

Reviewed by Andrew Bland, MD, FACP, FAAP · v1.0 draft 2026-09-26. For education; the physician’s written order and the unit protocol always govern.


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[Website version](https://urinenephrology.org/mastery/maintenance-hd/nursing/N8-Catheter-Care-and-Infection-Bundle.html) · Markdown synchronized October 3, 2026.