Spotting a central line infection at home

This page is for people with a central line at home, especially after a transplant, and the people who help them. It explains the signs of a line infection and how fast to call about each one.

Call 911 if you become very unwell very quickly — shaking chills with a high temperature, confusion, or a sudden inability to stay awake or breathe comfortably. Do not drive yourself. A germ that reaches a central line has direct access to the bloodstream. That is why rapid deterioration is treated as an emergency, not as something to sleep on.

Call your care team immediately, at any hour, for a temperature of 100.4 °F (38 °C) or higher. That is the figure CDC gives for infection during cancer treatment. CDC calls a fever during chemotherapy a medical emergency, and a transplant also weakens your defences against infection. So a fever is not a message to leave for the morning. If nobody answers within a few minutes, go to an emergency department. Tell them at once that you have had a transplant and have a central line. Do not take anything to bring the temperature down before you speak to your team. NCI warns that these medicines can hide signs of a more serious problem.

Call your care team right away, at any hour, for the other signs MedlinePlus lists: redness at the site or red streaks around it, swelling or warmth at the site, yellow or green drainage, and pain or discomfort. MedlinePlus says to tell your provider or nurse right away about any of these (MedlinePlus). Call right away too if the line gets dirty, appears to be coming out of the vein, is leaking, or if the catheter is cut or cracked.

MedlinePlus explains a central line simply. It is a catheter placed in a vein that leads to the heart or nearby large vessels. An infection happens when bacteria contaminate that tube.

That description contains the whole reason for the fuss. A scratch on your arm has to work hard to cause serious illness. A germ on a line hub does not — it has a short, direct route inward. This is why hospitals treat central line care as a precise procedure rather than a casual one.

The line is helping you. It is also a door into your bloodstream, so it gets watched.

Looking at the site once a day, in good light, is enough for most people. You are comparing today against yesterday.

• Is the skin around the site the same color, or is there new redness?
• Are there red streaks running away from the site?
• Is the area puffier or warmer than it was?
• Is anything leaking, particularly yellow or green fluid?
• Does it hurt or feel uncomfortable when it did not before?

MedlinePlus's prevention advice for patients is short. Do not touch your central line unless you have washed your hands. Dressings, whether gauze or tape, should be changed if they are dirty. In hospital, staff check the line every day to confirm it is in the right place and to look for signs of infection. At home, that job falls to you and whoever helps you.

It is possible for a line infection to declare itself as a fever with a completely normal-looking site. MedlinePlus includes fever in its list of central line infection signs precisely because it can arrive on its own.

NCI's infection page describes other signals worth knowing during cancer treatment. They include chills, cough, sore throat, diarrhoea, ear, head or sinus pain, and a stiff neck. They also include skin rash, mouth sores, swelling at catheter sites, and changes in urine. It states that infections during cancer treatment can be life threatening and require urgent medical attention.

So a temperature is a reason to ring in straight away, whatever the clock says. It is not a reason to wait and see whether the site catches up.

If you take one habit away from this page, make it hand washing before any contact with the line or dressing. If you take a second, make it the daily look. Between them they catch most of what a person can catch at home. Everything else is a phone call to a team that would far rather hear from you early.