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Central Line Associated Bloodstream Infections (CLABSI)

What is CLABSI?

Children who have a central venous catheter (central line) are at risk for central line-associated bloodstream infection, or CLABSIs. This infection can happen when germs enter your child’s blood.

A CLABSI can be serious and life-threatening. If your child has a central line and shows any signs of infection, contact your care team right away or go to the emergency room. Your care team will do tests to find the source of infection and recommend the appropriate treatment.

Central lines and CLABSI

A central line (central venous catheter) is a long, thin tube (catheter) that provides long-term venous (vein) access. It is placed into a large vein that ends close to the heart. Types of central lines include peripherally inserted central catheter (PICC line), tunneled central line, and subcutaneous port.

Central lines can be used to give medicines, fluids, blood products, and nutrition and are important for medical care and quality of life. They can often stay in place as long as your child’s treatment lasts (months to years).

A CLABSI can delay treatment and result in more medical procedures, such as surgery to remove and replace the line.

Learn more about central lines.

Symptoms of CLABSI

Child patient wearing a central line and a face mask

CLABSI is a serious health risk for patients with a central line. Contact your care team right away your child has any sign of infection.

Signs and symptoms of a central line infection may include:

  • Fever, oral temperature of 100.4 °F (38 °C) or higher, or follow fever guidelines as directed by your care team
  • Pain, stinging, or soreness
  • Redness, swelling, or warmth where the line comes out of the body
  • Drainage, leaking fluid, or a foul smell where the line comes out of the body
  • Blisters, rash, or skin sores 
  • Chills
  • Rapid heartbeat
  • Cough or fast breathing
  • Dizziness
  • Seizures
  • Drowsiness or hard to wake up
  • Nausea, vomiting
  • Sweaty skin
  • Irritated or crying without a good reason

A CLABSI is a serious health risk. Look for symptoms and behavior changes in your child. Contact your clinic right away if you notice changes. If you wait too long, germs will continue to grow, and the infection will be harder to treat. 

Causes of CLABSI

Central line infections in children with serious illness are usually caused by bacteria. Less commonly, CLABSI may be the result of a yeast or fungal infection.

Germs on skin

Germs, including bacteria and fungi, are common on the skin. Central line infections are often caused by skin bacteria.

The skin keeps germs from entering the body, but germs on the skin can get into the body through a central line. When your child’s immune system is weak because of illness or treatment, it is hard for their body to fight infection.

Germs in the mouth and intestines

Germs that live in the mouth and intestines, such as bacteria and fungi, can sometimes enter the bloodstream and cause serious infections, including CLABSIs. This is more likely to happen in patients with a weakened immune system or who have poor oral or gut health.

The mouth and intestines are normally protected by a lining called the mucosal barrier. But in children with serious illness, chemotherapy and radiation can damage the protective lining. This is called mucosal barrier injury (MBI). This can allow germs to enter the bloodstream and cause infection.

Diagnosis of CLABSI

The care team will do a physical exam and run tests to find the source of infection.

  • Blood cultures: A blood culture involves taking blood samples from the central line and at least 1 blood sample from a needle placed in a vein. These tests check to see if bacteria or fungi are present in the blood.
  • Other tests: Samples from other parts of the body, such as skin or urine (pee), may also be collected to help determine whether the infection is coming from the central line or another source. If the line is removed, the tip of the catheter may be tested (catheter tip culture).

Treatment of CLABSI

Treatment of CLABSI may include medicines and removal of the central line.

  • Antibiotic or antifungal medicines: Your care team will give medicines to fight the germs that cause the infection.
  • Removal of the central line: Your child’s central line may need to be removed to treat CLABSI. In some cases, the central line is replaced with a new device, sometimes at a different site. The central line may not be replaced until the infection is gone. If the central line is kept in place, it is important to give antibiotics through the line to treat the infection.
  • Supportive care: Your child may get medicines, fluids, or other treatments for fever and other symptoms to help make them more comfortable.

Your child will be watched closely during and after treatment. They need to take and finish medicines as instructed.

Central line infection in children with cancer or serious illness

Proper line care is the most effective way to reduce the risk of CLABSI. It is also important to know what may put your child at greater risk for infection. Children being treated for cancer and those who are in the hospital have a higher risk of infection, including central line infection. Other factors that increase risk for CLABSI in children with cancer include:

In some cases, factors about the central line may increase the risk of infection. These include:

  • Location of the central line in the body (lines in the groin have a higher risk than those in the chest or arms and legs)
  • Type of central line (implanted ports have the lowest risk)
  • Number of lumens (openings). Single lumens generally have a lower risk.
  • Central line problems, such as blockage or need for repair

How to prevent CLABSI

Before your child goes home with a central line, a care team member will teach you how to care for the line at home. Follow all steps for central line care and watch for signs of infection.

Limit the use of the central line when possible. Each time the central line is used, there is a risk of infection.

Avoid others who are sick.

  1. Wash your hands.

    • Wash your hands before and after caring for the central line. Clean your hands for 20 seconds. You must wash your hands with soap and water or use an alcohol-based hand sanitizer. Rub your hands, your fingertips, and the back of your hands. Dry your hands well after use. 
    • Be sure that all care team members and visitors wash their hands or use an alcohol-based hand sanitizer before they enter and exit your child’s room. 
    • Clean your hands if you: 
      • Enter or leave your child’s room 
      • Use the bathroom 
      • Change your child’s diapers 
      • Touch objects 
      • Clean your home 
      • Sneeze, cough, or blow your nose 
      • Touch body fluids such as blood or urine 
      • Touch pets 
      • Eat (before and after)
      • Feed your child (before and after) 
      • Come inside from outside 

  2. Keep the central line site clean and dry.

    • Care for the central line in an area that can be cleaned with a disinfectant wipe. Wipe surfaces thoroughly before line care.
    • Only family members or caregivers who have been trained by the hospital staff are allowed to care for the line.
    • Keep the central line site covered with a clean, dry dressing that stays tight to the skin. Make sure the dressing is changed every 7 days or more often if it gets wet, dirty, or loose.
    • Use a waterproof dressing cover to keep the central line and dressing dry when bathing.
    • Use aseptic technique to keep things as germ-free as possible when accessing the line. Wash your hands, wear disposable gloves if instructed, and use sterile supplies. Clean access points with alcohol or chlorhexidine as instructed. Allow them to air dry. Follow your care team’s instructions to “scrub the hub.”
    • Avoid touching the line when possible. Do not let visitors touch the line. 

  3. Keep your child and surroundings clean.

    • Make sure your child cleans their skin daily. Remember to keep the dressing dry. If your child cannot bathe or shower, use bath wipes as part of the daily cleaning routine as instructed.
    • Change your child's clothes twice daily – once in the morning and once in the evening (wake-up and bedtime). Change clothes if they become soiled.
    • Change bedding weekly, or right away if it gets dirty. Avoid reusing towels and washcloths.
    • Clean your home regularly to reduce the spread of germs. 
    • Store foods safely. Keep food items away from medicines and medical supplies.

  4. Take care of the central line.

    • Check lines regularly for breaks, cracks, leaks, tears, or blockages.
    • Keep the central line securely in place. Make sure nothing rubs or pulls on the line.
    • If your child wears diapers, make sure the line tubing does not get into the diaper. Always secure the central line away from the diaper area.
    • Follow the recommended care schedule for dressing, needle, caps, needleless connector, and tubing changes.
    • Take note if the length of the line outside your child’s body is suddenly shorter or longer. Call your care team.

  5. Practice good oral care.

    • Brush teeth at least twice each day. Use a soft toothbrush and fluoride toothpaste. For babies or patients with mouth sores, use a moist gauze pad or oral sponge.
    • Replace the toothbrush regularly, especially if your child has a weak immune system or neutropenia. Use a new toothbrush after illness.
    • Use a mouth rinse as recommended.
    • Put lip balm on your child's lips to keep germs from entering through cracked lips. 
    • Drink plenty of fluids to stay hydrated and help prevent dry mouth.

  6. Watch for signs of infection.

    • Call your doctor if you see any sign of infection, including fever or chills, or if the skin around the central line is red, swollen, or sore.

When to call your care team

Contact your care team if you notice any of the following: 

  • Redness, pain, warmth, swelling, or bulging veins at the central line site
  • Fluid, blood, or pus leaking from the central line site 
  • Bleeding at the central line site
  • Swelling in the face, neck, shoulder, chest, or arm on the side of the body where the central line exits the body
  • Fever of 100.4 °F (38 °C) or higher, or as directed by your care team
  • Chills, nausea, weakness, chest pain, shortness of breath, fast heartbeat, dizziness, or confusion
  • The line is blocked, leaking, will not flush, or has moved out of place

Questions to ask your care team 

  • Is my child at risk for CLABSI?
  • What steps are taken to prevent CLABSI in the hospital?
  • How can I help prevent CLABSI at home?
  • What signs of infection should I watch for?
  • How is CLABSI diagnosed?
  • How long does it take to get blood culture results?
  • How is CLABSI treated?
  • Will my child’s central line need to be removed if they have CLABSI?
  • When should I call the care team or go to the emergency room?

Key points about CLABSI

  • Children with central lines are at risk of a serious blood infection called central line-associated bloodstream infection, or CLABSI.
  • Germs can enter the bloodstream through the central line or from the mouth or intestines (mucosal barrier injury).
  • Signs and symptoms of CLABSI include fever, chills, redness, swelling, pain, or pus around the central line site.
  • If your care team suspects CLABSI, they can do blood tests to find the source of infection.
  • CLABSI is usually treated with antibiotics or antifungal medicines. In some cases, the central line may need to be removed or replaced.
  • Follow your care team’s instructions for central line care and infection prevention.
  • Seek medical care right away if your child has a central line and you notice signs of infection.

More resources on CLABSI

—
Reviewed: February 2026

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