How to tell if a PICC line is infected? Your guide to recognizing symptoms.

October 12, 2025 •

4 min read

Patients with central lines, such as a Peripherally Inserted Central Catheter (PICC), face the risk of Central Line-Associated Bloodstream Infections (CLABSIs), making it essential to know how to tell if a PICC line is infected. Proper education on early symptoms is crucial for patient safety and timely treatment.

Quick Summary

A PICC line infection can manifest as local inflammation like redness and swelling at the insertion site, or as a systemic issue with fever and chills. Early detection is vital to prevent serious complications.

Key Points

Monitor the Insertion Site: Regularly check for increasing redness, swelling, warmth, tenderness, or any drainage (especially pus) at the PICC line entry point.
Watch for Systemic Symptoms: Be alert for general illness signs like fever over 100.4°F (38.0°C), chills, and fatigue, which could signal a serious bloodstream infection.
Measure for Swelling: Keep track of the circumference of the arm with the PICC line, as unexpected swelling can be a sign of a blood clot or infection.
Differentiate from Phlebitis: Understand that mild pain and redness along the vein soon after insertion might be phlebitis, an irritation that usually subsides within a few days, unlike infection.
Seek Immediate Care: If you suspect an infection based on symptoms like fever or drainage, contact your healthcare provider right away, as prompt treatment is vital to prevent serious complications like sepsis.
Do Not Self-Treat: Never remove the catheter or apply unauthorized ointments; instead, contact a medical professional for guidance and a proper diagnosis.

A Peripherally Inserted Central Catheter, or PICC line, is a thin, flexible tube inserted into a vein in the arm, threading up to a larger vein near the heart. It is used for long-term delivery of medication, fluids, and nutrition, or for frequent blood draws. While incredibly beneficial, it also provides a potential entry point for germs, leading to infection. Being able to recognize the signs of an infection—both local and systemic—is a critical skill for any patient or caregiver.

Recognizing Localized Signs of Infection

An infection can start at the catheter's exit site on the arm. This is a localized infection and may be easier to spot by visually checking the area during dressing changes. Signs and symptoms can appear within a few days of insertion or weeks later.

What to look for at the insertion site

Redness (erythema): Increased redness around the catheter's entry point is a primary indicator. In darker skin tones, this may appear as a darker hue, purple or gray discoloration, or an increased shine, making visual comparison to surrounding skin important.
Swelling: The area may become swollen and puffy (edema). Measuring the arm's circumference can help track this change over time.
Warmth: The skin around the site may feel warm or hot to the touch.
Pain or tenderness: Patients may experience increased pain or tenderness at the insertion site that worsens over time.
Drainage (Exudate): Any pus or a bad-smelling fluid draining from the site is a definitive sign of infection and requires immediate medical attention. Yellow or green drainage is particularly concerning.
Red streaks: Red streaks leading away from the insertion site along the arm, known as lymphangitis, indicate the infection is spreading through the lymphatic system.

Recognizing Systemic Signs of Infection

If the infection spreads into the bloodstream, it becomes a much more serious condition known as a Central Line-Associated Bloodstream Infection (CLABSI). Systemic infections present with body-wide symptoms and require urgent medical intervention. Systemic symptoms can occur with or without visible signs at the insertion site.

Symptoms of a bloodstream infection

Fever and chills: A fever of 100.4°F (38.0°C) or higher, often accompanied by shaking chills (rigors), is a classic sign of a CLABSI.
Elevated heart rate (tachycardia): The body's response to infection can cause an increased heart rate.
Feeling unwell (malaise): A general feeling of sickness, fatigue, or confusion can be a systemic sign.
Drop in blood pressure (hypotension): This can occur in more advanced cases of sepsis.
Other general symptoms: A racing heartbeat, weakness, or unexplained fatigue can also be associated with a bloodstream infection.

Differentiating Infection from Other Complications

Not all discomfort related to a PICC line indicates infection. Other complications like phlebitis (vein inflammation) and thrombosis (blood clots) can have similar symptoms. Being able to distinguish between them is helpful, though a healthcare provider should always be consulted for a definitive diagnosis.


Feature	Signs of Local Infection	Signs of Mechanical Phlebitis	Signs of Thrombosis (Blood Clot)
Onset	Can be delayed; may worsen over time.	Typically occurs 24-72 hours after insertion.	Can develop at any time; sometimes subtle.
Symptom Focus	Centered on the insertion site.	Pain and redness along the vein from the insertion site.	Pain, tenderness, or swelling in the arm, neck, or face on the same side as the PICC.
Key Signs	Pus, discharge, persistent redness, and swelling.	Redness, warmth, and pain that typically subsides with warm compresses within 48 hours.	Swelling that does not subside, firmness along the vein, bulging veins.
Systemic Symptoms	Present with fever, chills, malaise.	Not typically present.	Rarely accompanied by fever unless an infection is also present.
What to do	Contact your healthcare provider immediately.	Can be managed with warm compresses and arm elevation initially, but contact provider if symptoms persist or worsen.	Seek immediate medical evaluation as this can be serious.

Immediate Steps if an Infection is Suspected

If you or a caregiver notices any signs of a potential PICC line infection, it is crucial to take prompt action. Early treatment with antibiotics is often necessary and can prevent the condition from escalating into a dangerous case of sepsis.

Do not panic: It is common for PICC lines to experience some initial irritation. However, you must take symptoms seriously.
Contact your healthcare provider immediately: Call your doctor's office, nurse advice line, or home health nurse. If it's after hours and you have systemic symptoms like fever or chills, go to an emergency department or call 911.
Do not remove the line yourself: This can be dangerous and is not the correct procedure.
Do not apply creams or lotions: Applying any ointment, especially under the dressing, can trap bacteria and worsen the infection.
Wash your hands: Always practice proper hand hygiene before and after touching the catheter or dressing.

Conclusion

Maintaining vigilance in monitoring a PICC line for signs of infection is a crucial part of patient care. Recognizing symptoms like localized redness, swelling, and drainage, as well as systemic signs like fever and chills, enables early intervention. Differentiating these symptoms from other complications like phlebitis is important, but any persistent or concerning symptom should always be promptly reported to a healthcare provider. Following proper care protocols, which include hand hygiene and keeping the dressing clean and dry, is the best way to prevent infections and ensure the continued safe use of the catheter.

For more information on preventing hospital-acquired infections, including CLABSIs, consult the Centers for Disease Control and Prevention (CDC).

Frequently Asked Questions

The first signs of a PICC line infection typically include increased redness, swelling, warmth, and pain at the insertion site on the arm. You may also notice a bad smell or pus-like drainage from the area.

Yes, it is possible to have a localized PICC line infection at the insertion site without developing a fever. However, a fever is a key sign that the infection has entered the bloodstream (CLABSI) and requires immediate medical attention.

Phlebitis, or vein inflammation, often causes pain and redness along the vein shortly after insertion but typically improves with warm compresses. A bacterial infection is more likely to show persistent or worsening redness, swelling, pain, drainage, and possibly a fever.

If you notice any discharge, especially pus or drainage with a foul odor, you should contact your healthcare provider or home health nurse immediately. This is a serious sign of infection and requires prompt medical evaluation.

Yes, if a PICC line infection spreads into the bloodstream and is not treated quickly, it can lead to sepsis, a life-threatening complication where the body's immune response to an infection is overwhelming. Early recognition and treatment are critical to prevent this.

Not necessarily. For some minor, localized infections, a course of antibiotics may be sufficient to clear the infection while keeping the line in place. However, if the infection is severe (CLABSI) or if it doesn't respond to antibiotics, the line will likely need to be removed.

Prevention involves strict hygiene, such as regular handwashing, scrubbing the catheter hub before access, and keeping the dressing clean, dry, and intact. Also, avoiding strenuous activities and swimming can help reduce the risk of infection.