Hematologist
CION Cancer Clinics
Line infection: recognising it early | CION Cancer Clinics
A fever of 38 degrees Celsius or higher, or shaking chills when the line is flushed, are the earliest signs of a central line infection. Redness, pain, swelling or pus where the line leaves the skin are the other warning. With low blood counts the skin may look normal, so act on fever or shivering alone and go to the emergency department the same day. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What are the early signs of a line infection?
- Where can a line infection show up?
- What happens when you arrive with a suspected line infection?
- What do families often get wrong about line infections?
- What do the terms on the discharge summary mean?
- Who is most at risk, and what can this page not tell you?
- Common questions about line infections
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If you have a line and a fever or shivering now
Go to the nearest emergency department today, or call 108 if you cannot travel safely. This applies to a temperature of 38 degrees Celsius or higher, and also to shivering or chills that start during or soon after the line is flushed, even with no fever. At the desk, say "blood cancer treatment, central line, fever." Do not flush the line again at home, and do not wait for the morning to see if it settles.
The short answer
What are the early signs of a line infection?
The earliest signs are often a fever, or shivers that come on when the line is flushed or used. Redness, pain, swelling or pus where the line leaves the skin are the other early warning, and they need a same-day call to your team.
Why the signs can be quiet
A central line is a thin tube that runs from the skin into a large vein near the heart. Hickman lines, PICC lines and ports are all types. Germs that settle on the tube can pass straight into the blood. When your white cell count is low, your body cannot make the usual redness and pus around an infection. So the skin may look almost normal while germs are already in the blood. A fever or a shiver may be the only clue you get.
Why shivers after a flush matter so much
When the nurse or a family member flushes the line, saline pushes anything sitting inside the tube into the bloodstream in one go. If germs are living on the inside of the line, that push can bring on sudden chills, shaking, a racing heart or feeling faint within minutes. This is one of the most specific signs that the line itself is the source.
You do not need to be sure it is the line. Any fever with a line in place is treated as a possible line infection until proven otherwise.Not sure whether this applies to you?
Ask an oncologistWhere to look
Where can a line infection show up?
An infection can sit in one of three places. Each one looks different, and more than one can happen at the same time.
At the exit site
This is the spot where the line comes out of the skin. Look at it each time the dressing is changed, in good light.
Signs to report the same day
- Redness spreading outwards
- Pain or warmth when touched
- Pus, or a wet, smelly dressing
Along the tunnel
A Hickman line runs under the skin for a short distance before it enters the vein. A port sits in a small pocket under the skin. Infection here shows as a tender, red or hard stripe along the track, or a swollen, sore area over the port.
In the blood
This is the most serious kind and often the least visible. The skin may look clean. The signs are in the whole body instead.
Look out for
- Fever, or a very low temperature
- Shivers when the line is used
- Confusion, fast breathing, feeling faint
At the hospital
What happens when you arrive with a suspected line infection?
The order differs between hospitals. The aim is the same: samples first, antibiotics quickly, then a decision about the line.
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A quick check of how unwell you are
Temperature, pulse, blood pressure and breathing are measured. The exit site and any tunnel or port are examined. Tell the staff when the fever or shivers started and whether it happened during a flush.
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Blood cultures from two places
A blood culture is a test that tries to grow germs from a blood sample. One sample is usually drawn through the line and one from a vein in the arm. Comparing the two helps show whether the line is the source.
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Antibiotics without waiting for results
Culture results take days. With low counts, doctors start broad antibiotics quickly, often through the line itself, and adjust them once they know which germ is growing.
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A decision about the line
Many line infections settle with antibiotics while the line stays in. Sometimes the line has to come out, for example with certain germs, a tunnel infection, or a fever that does not settle. Your team explains which applies to you.
Commonly believed
What do families often get wrong about line infections?
"The site looks clean, so the line cannot be infected."
A clean exit site does not rule out an infection inside the line or in the blood. With a low white cell count, the skin often shows nothing at all. Fever or shivering is the sign to act on, whatever the dressing looks like.
"A paracetamol at home will tell us if it is serious."
A fever tablet can bring the temperature down and hide the one sign doctors need to see, while the infection carries on. Check with your team before giving any fever tablet, and go in first.
"Shivering after a flush is just the cold saline."
A flush should not make you shake. Chills, a racing heart or feeling faint soon after the line is used can mean germs were pushed into the blood. Treat it as an emergency even if the temperature is normal at that moment.
"If the line gets infected, someone at home did something wrong."
Careful handling lowers the risk, but line infections still happen to people who do everything right. Low counts and a tube in a vein for weeks are risks on their own. Spotting it early matters far more than finding someone to blame.
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Words you may hear
What do the terms on the discharge summary mean?
- Exit site infection
- Infection limited to the skin where the line comes out. It is usually the easiest kind to treat.
- Tunnel or pocket infection
- Infection along the track under the skin, or around a port. It often means the line or port has to be removed.
- CLABSI or CRBSI
- Short forms for a bloodstream infection linked to a central line. It means germs were found in the blood and the line is the likely source.
- Blood culture positive
- Germs grew from the blood sample. The report names the germ, which guides the choice of antibiotic.
Being straight with you
Who is most at risk, and what can this page not tell you?
Anyone with a central line can get a line infection. The risk is higher when the white cell count is very low for a long stretch, as in treatment for acute leukaemia or before and after a transplant. It is also higher when the line is used many times a day, or when the dressing gets wet or lifts at the edges.
What helps lower the risk at home
Keep the dressing dry and closed. Wash your hands well before anyone touches the line. Do not let visitors handle it. Follow the flushing and dressing plan your nurse gave you exactly.
What this page cannot tell you
It cannot tell you whether a particular redness or fever is a line infection, or whether your line will need to come out. Those depend on your examination, your blood cultures and your treatment plan. Your treating haematology team makes those calls, and they would always rather see you early than late.
If you are not sure whether a sign counts, call your team the same day and describe it. A photograph of the exit site can help them decide.Questions we are asked
Common questions about line infections
My father shivered badly after his line was flushed but has no fever. Should we still go?
Yes, go to the emergency department today. Shaking chills soon after a flush can be the first sign that germs inside the line have entered the blood. The fever often follows within hours. Tell the staff exactly when the shivering started and that it began during the flush, because that detail points to the line.
The skin around the line is a little pink. Is that an infection?
Not always. A small pink area can come from the dressing adhesive or rubbing. Redness that spreads, feels warm, hurts, or comes with pus or a wet dressing needs a same-day call. A photo sent to your team helps them judge it.
Will the line have to be taken out?
Not necessarily. Many line infections settle with antibiotics while the line stays in. Removal is more likely with an infection along the tunnel or port pocket, with certain germs, or if the fever keeps returning despite treatment. Your haematologist will explain the reason for whichever choice is made.
Is a PICC line safer than a Hickman line from infection?
Each type has its own balance of risks, and the choice depends on how long the line is needed, how it will be used and your blood counts. No type is free of infection risk. Ask your team why they chose your line.
Can we flush the line at home to check if it is blocked?
Only if your nurse has trained you and it is part of your written care plan. If there is a fever, shivering or pain around the line, do not flush it at home at all. Flushing an infected line can push germs into the blood. Go to hospital and let the staff handle it.
Can a line infection happen weeks after the line was put in?
Yes. Infections can appear at any point while the line is in, and sometimes shortly after it is removed. The risk tends to be highest when counts are at their lowest after a treatment cycle. Keep checking for as long as the line stays.
Is it safe to bathe with a central line?
Most people can wash, but the line and dressing must stay dry. A bucket bath with the dressing covered in a waterproof cover is common. Avoid pools and soaking in a tub. If the dressing gets wet or peels, call your nurse to have it changed the same day.
How can CION help if we are worried about a line?
If there is fever or shivering, go to the nearest emergency department first. For worries that are not urgent, share your reports and a photo of the site with the helpline. CION's haematology team can review your case and help you reach the right team for line care or removal where that is needed.
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Sources
- National Cancer Institute — Infection during cancer treatment
- NICE — Neutropenic sepsis: prevention and management in people with cancer (CG151)
- NHS — Sepsis
- Macmillan Cancer Support — Cancer treatment information
- National Health Mission — National Health Mission
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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