Implanted Port Infections, Beating PICC Line Issues

Most parents or caregivers can easily rattle off the signs and symptoms of the common cold or strep throat. But do you know the signs and symptoms of a local or systemic infection caused by a PICC (peripherally inserted central catheter) line or implanted port?  

PICC lines and implanted ports are very useful for children who will need multiple rounds of medications, chemotherapy, or blood work. However, both involve risks. The largest risk associated with PICC lines and implanted ports is infection.  

PICC Line and Implanted Port

A PICC line or implanted port provides nurses with a direct line to administer chemotherapy, medications, or nutrition directly to your child’s bloodstream. This access to the body is wonderful for treatment but also means that germs and bacteria can potentially have easy access to the bloodstream. 

Proper Preparation to Decrease Infection

An infection may occur if the site of the PICC line or implanted port is not placed following sterile procedure guidelines or is not properly cared for once inserted. It is helpful to know a little bit about the procedure itself so you know what to look for when it is being done on your child. Typically, the nurse (or other healthcare provider) will take multiple precautions to ensure the environment is sterile during the insertion process. 

• They may ask extra visitors to leave the room to limit the number of germs in the room. 
• The nurse, any remaining family in the room, and the child (if possible) should put on a facemask.
• Before inserting the device, they will perform hand hygiene, clean the insertion area very well, and use all sterile supplies to ensure no germs are present in the area. 

If you notice that any of these are not happening, ask questions! One hospital’s sterile procedure may look different than another, and it never hurts to ask for an explanation or clarification.

Increased Risk of Infection

Unfortunately, cancer decreases your child’s immune system and the ability to fight off infections.

Neutropenia

White blood cells are the part of the blood that helps to fight off infections in the body. Low levels of white blood cells are common during cancer treatment. Decreased white blood cell counts is called neutropenia. Without a high level of white blood cells, your child is more susceptible to infection.

Nutrition

Decreased nutritional status, which may occur if your child is not eating well during treatments, can also put them at an increased risk of infection.

Hospitalization

Frequent hospitalizations or time spent in healthcare facilities increase the risk as well. You and your family cannot avoid hospitals or healthcare facilities as these are places that will provide treatment for your child.

Signs and Symptoms of an Infection

Local Infection

Local infection happens right at the device site. Sign or symptoms may include: 

• Redness
• Drainage
• Soreness at the site
• Swelling at the site
• The site may be hot to the touch

Systemic Infection

A systemic infection is one that occurs throughout the body because the bacteria causing the infection has entered the bloodstream. Signs of infection may include: 

• Fevers
• Chills
• Changes in behavior
• Confusion
• Racing heart rate

Any of the signs of a local or systemic infection should be evaluated immediately by your child’s healthcare provider. The quicker an infection is identified, the quicker treatment can begin.

Treatment for PICC Line or Implanted Port Infection

Despite doing everything possible to decrease your child’s risk of infection, one may still occur. If your child does end up with an infection, they may be hospitalized for intravenous (IV) antibiotics. These are medications used to treat the infections and fight off the bacteria causing them. Any symptoms that developed because of the infection will also be treated if necessary at this time. For example, if your child developed a fever, they may receive acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to combat the high temperature. IV fluids may be given as well to keep your child hydrated while fighting the infection. 

The implanted port or PICC line may be removed during the hospitalization and a new one will be placed after the infection clears. Depending on the type of bacteria causing the infection, the IV antibiotics may be switched to oral antibiotics so your child and family can finish recovering in the comfort of home.

How to Help Prevent Site Infection

Hand Washing

It sounds simple and redundant, but hand hygiene is vital. Hand washing is one of the most important ways to prevent infection. Children constantly touch anything and everything which can means contact with a large variety of germs. From toys to the floor to walls to door handles, everything can have germs. So, frequent hand washing is imperative. 

Of course, you cannot and should not spend all your time worrying about hand washing. Find a process that works best for you and your family. Maybe make it a house rule that every time someone gets home, their first stop is to the bathroom to wash their hands. This rule can be transferred to the hospital and occurs every time someone enters the hospital room. Encourage children to sing songs to ensure the length of washing is appropriate, and make it a fun game for them.

Avoid Touching Site

Avoid touching the implanted port or PICC line. Ask your healthcare team what you can use to cover up the device area to keep it out of your child’s reach. In the winter, it may be covered by a shirt, but in the summer, it could be wrapped up with a brightly colored stretchy band or sleeve to avoid contact with anyone’s hands. If the bandage that is covering the device starts to peel off, notify your nurse for assistance with changing the covering.

Avoid Sick Contacts

It can be hard to limit your child’s time with friends or family during treatments. If there is any chance they are sick or were around someone who is sick, they should avoid seeing your child. Germs can be passed around rapidly, and someone easily fighting off a small cold may not realize the effect their cold could have on others.

Avoid Sharing

Avoid sharing items such as toothbrushes, cups, lip balm, or snacks. This is another way germs are quickly spread from person to person.

Clean Items Frequently

Regularly wash toys that are played with, especially by multiple children. Disposable wipes or soap and water are the easiest way to do this. Any blankets or stuffed animals that are used frequently or brought out into public should also be washed often.

Risk of Foodborne Illness

Certain foods should be avoided due to a higher risk of foodborne illnesses. Fresh fruits or vegetables that are not washed well, unpasteurized dairy items such as cheese, raw/lightly cooked fish, and raw/soft-cooked eggs should be limited or avoided if possible (Cancer Diet: Foods to Add and Avoid During Cancer Treatment, 2021).

The risk of an infection caused by a PICC line or implanted port can be scary for everyone. This is a great resource for you and your family so you can be informed about the medical care your child is receiving and have the information needed to take swift action in the case an infection develops.   

References:

Cancer diet: Foods to add and avoid during cancer treatment. (2021, October 26). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/cancer/cancer-diet-foods-to-add-and-avoid-during-cancer-treatment