Central line-associated bloodstream infection: warning signs and what to do

Cancer Research UK explains that a central line is a long flexible plastic tube that ends in a central blood vessel in the chest, close to the heart. Types include acute central lines, tunnelled central lines, peripherally inserted central catheters (PICC lines) and implanted ports. They are used to give chemotherapy and other treatment, take blood samples and give fluids or antibiotics, so people do not need needles into the hand or arm each time.

Because the line passes through the skin and sits in a large vein, germs can travel along it into the blood. The NHS sepsis page lists having a burn, cut or wound or a skin infection, and a weakened immune system as factors that make sepsis more likely. When bacteria enter the bloodstream from a line, the infection is called a central line-associated bloodstream infection (CLABSI).

Cancer Research UK advises speaking to your chemotherapy nurse or doctor if you notice redness, swelling, oozing or soreness where the line enters the body. Cambridge University Hospitals, in its PICC patient leaflet, says redness around the line, a discharge from the entry site, a temperature above 37.5 degrees, fever, chills or feeling generally unwell could mean you have an infection. It also asks people to report a cold and shivery feeling during or after a line flush.

The leaflet lists general signs, such as fever, chills and feeling unwell, alongside local ones such as redness and discharge, so a high temperature or shivering should be reported even if the skin around the line looks normal. Cancer Research UK adds that people who have problems at home should contact their advice line.

• Redness, swelling, oozing or soreness at the line site.

• Discharge from the entry site.

• A temperature above 37.5 degrees, fever or chills.

• Feeling generally unwell, or a cold and shivery feeling after a flush.

The NHS says sepsis usually develops quickly over a few hours and, if not treated, can turn into septic shock. Common symptoms in adults include confusion or slurred speech, uncontrollable shivering, muscle pain, difficulty breathing, blue, pale, grey or blotchy skin, lips or tongue, a high or low temperature, and not peeing all day or very little in the past 18 hours.

The NHS advises calling 999 or going to A&E if an adult or child aged 5 or over is breathing very fast, is confused or has slurred speech, has blue, pale or blotchy skin, has a very high or very low temperature or is shivery, has a rash that does not fade, or has symptoms you are worried might be sepsis. It says not to drive to A&E but to ask someone to drive you or call 999. For babies and children under 5, the NHS gives a separate list of signs. People who have a central line and any of these signs should say so straight away.

Cancer Research UK says that if an infection develops you will need treatment with antibiotics straight away, and otherwise a doctor or nurse may have to remove the line and put a new one in. The NHS explains that sepsis is treated in hospital with antibiotics, oxygen to help with breathing and fluids given into a vein, and that sometimes treatment in a specialist care unit is needed so a person can be closely monitored.

The NHS says sepsis is a serious condition and it can take weeks or months to recover, and offers suggestions such as being patient, getting enough sleep and building up exercise gradually. It points to The UK Sepsis Trust for support.

Cambridge University Hospitals advises keeping the dressing clean and dry, never opening the clamps or removing the end caps because these prevent air and germs entering the bloodstream, avoiding sharp objects near the line, and not applying creams or lotions to the insertion site. It says showering is fine with a waterproof cover but the line must not be submerged because of the risk of infection. It explains that anyone using the line should be trained, should clean the end of the line with an antiseptic wipe before use and should use an aseptic non-touch technique.

Cancer Research UK says it is very important to avoid getting an infection in the area where the line goes into the body, that you can have a bath or shower as long as the line does not go under water, and that district nurses can arrange to help at home until you are confident. If you are not having treatment regularly, the line needs to be cleaned and flushed weekly to keep it clear.