Emergency Room Visit When You Have a Catheter

Going to the emergency room is stressful under any circumstances. When you have a PICC line, implanted port, tunneled catheter, or other central access device, there are specific things you need to communicate and specific situations to navigate to protect your catheter and your safety.

This guide prepares you for an ER visit so you can advocate effectively for yourself, even when you feel unwell.

What to Tell Triage — Immediately

When you check in at the emergency triage desk, immediately tell the triage nurse:

That you have a central catheter — name the type: “I have a PICC line in my right arm” or “I have an implanted port in my chest” or “I have a tunneled catheter (Hickman) in my chest.”
Why you are coming in — your chief complaint, particularly if it is related to your catheter or treatment (e.g., “I have a fever and chills and I’m on home IV antibiotics through my PICC”).
Your primary care or specialist’s name and contact number — so the ER team can reach them if needed.

This information directly affects triage priority. Fever in a patient with a central catheter is treated with higher urgency than fever in a patient without one.

What to Bring to the ER

Your medication list (carry it in your wallet or phone at all times)
Your port ID card (if you have an implanted port)
Your physician’s letter describing your device and treatment
Your allergies list
The name and after-hours phone number of your home infusion team, oncologist, or infectious disease physician — the ER may need to consult them
A companion if possible — to help communicate when you feel unwell and to be a second set of ears

The Most Urgent Scenario: Fever with a Central Line

If you are coming to the ER with fever (≥38°C / 100.4°F) and shaking chills, and you have a central catheter (PICC, port, tunneled catheter), the ER team will treat this as a possible central line-associated bloodstream infection (CLABSI) until proven otherwise. This is appropriate and you should support this approach.

What to expect the ER to do:

Draw blood cultures — from multiple sites. Standard practice is to draw at least 2 sets of blood cultures. Ideally, one set is drawn through the central catheter and one set is drawn from a peripheral vein (arm stick). This helps determine whether the infection is catheter-related. If you have an implanted port, it will be accessed for one set.
Start IV antibiotics promptly. Broad-spectrum IV antibiotics are started as soon as cultures are drawn — typically within 1–3 hours of arrival. Do not leave the ER before antibiotics are administered if infection is suspected.
Other labs: Blood count (CBC), metabolic panel, and other tests to assess your overall status.
Assessment of the catheter site: The ER team will examine your exit site (for PICC, tunneled catheter) or assess the accessed port for signs of local infection.
Decision about catheter removal: In many cases, the catheter does not need to be removed in the ER — the decision is made based on culture results, the type of organism identified, and whether the infection can be cleared with antibiotics. However, if there is clear evidence of a tunnel infection, pocket infection (for ports), or certain highly virulent organisms, urgent removal may be recommended. This decision should ideally involve your primary treating physician (oncologist, ID physician) — ask the ER team to contact them before making this decision if time allows.

Protecting Your Catheter in the ER

The single most important rule: tell them before they touch

ER staff — doctors, nurses, and technicians — see hundreds of patients and may not initially notice or consider your existing central catheter. You must proactively communicate:

“I have a PICC in my right arm — please do not place any IVs, blood pressure cuffs, or draw blood from that arm.”
“I have an implanted port in my chest — I need a specially trained nurse to access it with a Huber needle. Please do not use it with a regular needle.”

Protecting the PICC arm

Blood pressure must never be taken on the PICC arm — remind every person who approaches with a BP cuff
The ER team should not attempt to draw blood from the PICC arm vein, place a peripheral IV in the PICC arm, or apply a tourniquet to the PICC arm

Accessing your port correctly

An implanted port must be accessed with a Huber needle (non-coring needle). Using a regular sharp needle to access a port can permanently damage the silicone septum. Most ERs have Huber needles, but some smaller facilities may not. Specifically tell the ER nurse: “My port must be accessed only with a Huber needle — not a regular needle.”

If the ER does not have a Huber needle or a nurse trained in port access, peripheral IV access in an arm vein is the safer alternative until the correct equipment and training are available.

Managing the PICC dressing

If the ER team needs to examine, use, or troubleshoot your PICC, ensure that aseptic technique is used when touching the catheter hub. You can advocate for this: “The connections should be scrubbed with alcohol before use — this is standard infection prevention.”

What the ER May Want to Do with Your Catheter

Start an infusion through your existing catheter

The ER will likely want to use your central catheter to deliver IV fluids and medications. This is appropriate as long as:

The catheter is confirmed to be in correct position (for a PICC: the external length is as expected; no pain on flushing)
The catheter is flushed with saline and flushes freely without resistance
Proper aseptic technique is used

Draw blood through your catheter

Expected and appropriate for the blood culture (one set), especially for suspected catheter infection. The catheter must be flushed and blood return confirmed first.

Remove your catheter

If the ER team recommends removing your PICC or tunneled catheter in the ER, consider:

Requesting that your primary physician (oncologist, ID doctor) be consulted first if your condition is not immediately life-threatening. Catheter removal decisions affect your ongoing treatment plan.
Asking: “Will removing the catheter affect my ability to continue my treatment? Is there a plan for replacement access?”
For implanted ports: ER removal of a port is uncommon and typically involves a surgeon. If port removal is recommended urgently, there is usually a clear reason; ask for an explanation.

There are situations where immediate catheter removal is necessary — for example, tunnel or pocket infection, fungal bloodstream infection, or overwhelming sepsis not responding to initial treatment. In these cases, the catheter must come out and your safety takes priority over convenience.

If Your Catheter Falls Out in the ER (or Anywhere)

PICC or tunneled catheter falls out:

Keep the removed catheter — bring it to the ER or hand it to the nurse
Apply gentle pressure to the exit site
Do not try to reinsert it

Port needle dislodges:

Tell the nurse immediately; the needle must be removed and the site covered
The port itself (under the skin) is undisturbed; it can be re-accessed at a later time

Communicating When You Feel Very Unwell

If you are too ill to advocate clearly, a companion can speak for you. Before reaching that point:

Pre-program your doctor’s after-hours number in your phone under a name that’s easy to find
Carry a simple alert card in your wallet (see template below)
Let a companion know the key points in advance: PICC arm restrictions, port Huber needle requirement, your medications

Wallet alert card template:

I have a [PICC line in my right/left arm / implanted port in my chest / Hickman catheter in my chest]. Currently receiving: [medication name] NO BP or needles in my [right/left] arm. Port access requires Huber needle only. My physician: [Name] [Phone number] Allergies: [List]

After the ER Visit

If you are admitted

Your vascular access device and any changes (new IV lines placed, catheter accessed) will be communicated to your inpatient team. Ensure the floor nurses know about your existing device and any restrictions.

If you are discharged

Before leaving:

Understand what was found (or not found) and what the plan is
Ensure a follow-up plan is in place — with whom, when, and why
Ensure blood culture results (if drawn) will be followed up — cultures take 2–5 days; confirm who will call you with results
Ensure your primary physician has been or will be notified of the ER visit
Understand any new medications prescribed and whether your existing infusion should continue

This guide is for educational purposes. Emergency situations are dynamic and require clinical judgment. In any life-threatening emergency, the clinical team’s decisions about your safety take priority over catheter preservation.