Showering with a Central Line: Infection Prevention is Key
For many patients, a central line is a vital part of their medical treatment, but it also presents a significant risk of infection if not cared for properly. The most crucial rule for a central venous access device (CVAD) is to keep the insertion site and the dressing completely clean and dry at all times. Water, especially tap water, contains bacteria that can enter the bloodstream through a wet or compromised dressing, leading to a serious and potentially life-threatening bloodstream infection.
While you can take a shower with a central line, it is not without precautions. For this reason, many healthcare providers initially recommend sponge baths to eliminate any risk of water contact with the line. If showering is permitted by your healthcare team, you must follow a strict protocol using a reliable waterproof cover. Submerging the catheter site in water, such as in a bathtub, pool, or hot tub, is strictly prohibited.
Preparing for a Safe Shower
Following the correct preparation steps is critical to a safe showering experience. Gather your supplies before stepping into the shower to ensure a smooth and sterile process.
- Gather Supplies: Secure a commercial waterproof cover, such as Aquaguard® or Shower Shield, adhesive waterproof tape, and fresh towels. For some lines, household plastic wrap can be used as a temporary cover with proper taping, but commercial products often provide a more reliable seal.
- Prepare the Central Line: Before applying the waterproof cover, ensure all lumens (the ends of the catheter tubing) are tucked securely underneath the dressing. The entire dressing and insertion site must be fully enclosed by the waterproof barrier.
- Secure the Cover: Apply the waterproof cover, smoothing out the adhesive edges to create a tight seal against your skin. The waterproof cover should be large enough to completely overlap the original dressing on all sides.
Proper Showering Technique
Once prepared, follow these guidelines to minimize risk while showering:
- Use Warm Water, Not Hot: Hot water can loosen the adhesive on the waterproof cover, compromising the seal. Use warm water to help ensure the cover stays firmly in place.
- Keep Showers Short: Limiting the duration of your shower reduces the amount of steam and the chance of the cover failing.
- Avoid Direct Spray: Keep the central line site out of the direct stream of water. You may need to angle your body away from the showerhead or use a detachable shower wand to wash your back and other areas.
- Dry Before Removing the Cover: After your shower, gently dry the waterproof cover with a towel before you remove it. This prevents any water droplets from falling onto the dressing.
- Inspect and Assess: Immediately after removing the cover, inspect your central line dressing for any signs of wetness, moisture, or damage. Check the insertion site for any redness, swelling, or drainage.
Action After the Shower
If the dressing remains dry and intact, no further action is needed other than resuming normal care. However, if the dressing becomes wet, soiled, or loose at any point, it must be changed immediately. This is a critical step to prevent infection. You should have been trained on how to perform a sterile dressing change or have arrangements with a home health nurse to do so. In any case, you should inform your healthcare provider that the dressing became wet.
Comparison of Central Line Types and Bathing Considerations
While the general principle of keeping the site dry applies to all central lines, specific types have slightly different considerations.
| Feature | Peripherally Inserted Central Catheter (PICC) | Tunneled Central Venous Catheter (Hickman/Groshong) | Implanted Port (Port-a-cath) |
|---|---|---|---|
| Insertion Site | Upper arm, typically near the bicep | Chest or neck | Surgically placed under the skin on the chest |
| Showering Precautions | Requires a secure, waterproof cover over the entire dressing and arm | Requires a waterproof cover over the chest dressing; can use press-and-seal or larger commercial products | No special covering needed when not accessed |
| If Accessed (with needle) | Cover the dressing and tubing with a waterproof shield | Cover the dressing and tubing with a waterproof shield | Cover the accessed site with a waterproof dressing (e.g., Aquaguard®) |
| Submersion in Water | Strictly forbidden in baths, pools, hot tubs | Strictly forbidden in baths, pools, hot tubs | Allowed in baths/pools only when not accessed |
| Risk if Wet | High risk of infection spreading through the vein toward the heart | High risk of bloodstream infection from contaminated water | If accessed, high risk of infection; if not accessed, minimal risk |
Potential Risks and Warning Signs
The most significant risk associated with getting a central line wet is infection. The consequences of a CLABSI can be severe, including prolonged hospitalization and serious illness. It is essential to be vigilant and know the signs of infection.
- Signs of Infection at the Site: Redness, swelling, pain, warmth, or drainage around the insertion site.
- Signs of Systemic Infection: Fever, chills, or a general feeling of being unwell.
- Other Issues: The catheter breaking or leaking, or the dressing becoming loose or peeling back.
If you experience any of these symptoms, or if your dressing becomes wet, contact your healthcare provider immediately. The CDC offers extensive guidelines for preventing these infections.
Conclusion
With a proper waterproof cover and careful technique, it is possible for many patients to safely take a shower with a central line. The paramount goal is to keep the dressing completely dry to prevent infection. Always follow the specific instructions from your healthcare team regarding showering and dressing changes. If in doubt, a sponge bath is always the safest option to ensure the integrity of your central line and your overall health.
Best Practices for Central Line Hygiene
- Use a professional waterproof cover. Commercial products like Shower Shield or Aquaguard® are specifically designed for medical device protection and offer a more reliable seal than improvised solutions.
- Keep the shower short and use warm water. Excessively hot water and long showers can cause the adhesive on waterproof covers to fail, potentially exposing the dressing to water.
- Avoid baths and swimming. The risk of submerging the central line site and getting the dressing wet is too high. Opt for showers only when properly covered.
- Inspect the dressing immediately after showering. Check for any signs of wetness, moisture, or a compromised seal. If the dressing is wet, it must be changed immediately by a trained individual.
- Ensure proper hand hygiene. Anyone touching the central line or its dressing must wash their hands thoroughly with soap and water or use an alcohol-based sanitizer before and after.
- Clean the skin daily. Some healthcare providers recommend using an antiseptic skin cleanser like Hibiclens during showers to help reduce the risk of infection, but follow your doctor's instructions.
Showering with a Central Line Q&A
What happens if I accidentally get my central line wet in the shower?
If your central line dressing gets wet, you must have it changed immediately to prevent infection. Contact your healthcare team or home health nurse for guidance on getting a sterile dressing change as soon as possible.
Can I use plastic wrap and tape to cover my central line for showering?
While some patients use improvised methods like plastic wrap, commercial waterproof covers such as Aquaguard® or Shower Shield are more reliable and are recommended by healthcare providers. If using plastic wrap, ensure the edges are taped securely to prevent leaks.
Is a sponge bath a better option than showering with a central line?
Yes, a sponge bath is the safest method for maintaining hygiene, as it completely eliminates the risk of water contact with the central line and dressing. It is the recommended option for anyone uncertain about showering safely.
How often should a central line dressing be changed?
For most transparent dressings, the change is typically scheduled once a week, or sooner if it becomes wet, loose, or soiled. Follow your healthcare provider's specific instructions for your dressing type.
What are the signs of a central line infection?
Signs of a local infection at the site include redness, swelling, increased pain, warmth, or drainage. Systemic infection can cause fever, chills, and fatigue. If you notice any of these, contact your care team immediately.
How long can a central line stay in place?
Central lines are designed for long-term use, lasting weeks or months, depending on the type and purpose. The duration is determined by your healthcare team based on your treatment needs.
What other activities should I avoid with a central line?
In addition to avoiding baths and swimming, patients should also avoid any activities that could dislodge the catheter, such as contact sports or heavy lifting with the arm where a PICC line is inserted. Always ask your doctor about specific activity restrictions.
