# Suspected central line infection in a person with cancer: paired blood cultures, first antibiotics and line removal or salvage

Source: https://onco.cc/protocols/suspected-central-line-infection/  
OnCo record `suspected-central-line-infection` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A fever, shivering, or redness, pain or pus where a central line goes in can mean the line is infected. Blood is taken from the line and from an arm vein before antibiotics start, and antibiotics should not wait for the results. Some line infections can be cleared with the line left in; others, such as a serious infection or certain germs, mean the line has to come out.

## Summary

IDSA (2009, the current edition) and ESMO (2015) agree on the core. Take paired blood cultures, one through the catheter and one from a peripheral vein, before antibiotics, labelled by site (IDSA A-II; ESMO [II, A]); if no peripheral sample is possible, take at least two through different lumens (IDSA B-III; ESMO [III, B]). Clean the hub or skin with alcohol, iodine tincture or alcoholic chlorhexidine above 0.5% and let it dry (A-I). Swab any exit-site exudate (B-III). Growth from the catheter sample at least 2 hours before the peripheral sample (differential time to positivity) supports catheter-related bloodstream infection (A-II).

Start empirical antibiotics without waiting for cultures (ESMO): vancomycin where MRSA is common (IDSA A-II; ESMO [II, A]), with Gram-negative cover chosen from local susceptibility data, and combination cover for resistant Gram-negative bacilli such as Pseudomonas when the patient is neutropenic or septic (IDSA A-II). Suspect candidaemia in septic patients with haematological cancer, transplant or parenteral nutrition (B-II).

Remove a long-term catheter for severe sepsis, suppurative thrombophlebitis, endocarditis, bacteraemia persisting beyond 72 hours of appropriate antibiotics, or infection with S. aureus, P. aeruginosa, fungi or mycobacteria (IDSA A-II); ESMO adds tunnel infection and port abscess. Otherwise salvage can be tried with systemic antibiotics plus an antibiotic lock (B-II), with repeat cultures and removal if they are still positive at 72 hours (B-II). A single positive culture for coagulase-negative staphylococci should be repeated, paired, before treatment or removal (A-II).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: CRBSI; catheter-related bloodstream infection; line infection; port infection; PICC infection; Hickman line infection; tunnel infection; port pocket infection; differential time to positivity; line salvage; antibiotic lock

## Connected records

- protocols: [Blood sampling from a central line or port](https://onco.cc/protocols/blood-sampling-from-a-central-line/), [Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay](https://onco.cc/protocols/catheter-related-thrombosis-in-cancer/), [Central line and port removal: when, how and what to watch for afterwards](https://onco.cc/protocols/central-line-removal/), [Implanted port access, flushing and care in adults having cancer treatment](https://onco.cc/protocols/implanted-port-access-and-care/), [PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line](https://onco.cc/protocols/picc-and-tunnelled-line-care/), [Suspected febrile neutropenia (neutropenic sepsis): the first hour](https://onco.cc/protocols/febrile-neutropenia-first-hour/)
- technologies: [Catheter lock solutions (heparin, taurolidine and DefenCath)](https://onco.cc/technologies/catheter-lock-solutions/), [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/)

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