Makindo Medical Notes

🧾 About

• 🧪 The decision to urgently remove an intravascular catheter depends on clinical judgment, balancing severity of sepsis and the likelihood of catheter-related infection (Mermel et al., 2001).
• 📊 Use the Visual Infusion Phlebitis (VIP) score to guide treatment decisions. A high score warrants prompt action.

🩺 Clinical Assessment

• Check for systemic infection: fever, chills, rigors ❄️🤒.
• Inspect catheter site for:
  • 🔴 Redness, swelling, tenderness
  • 💧 Discharge or pus → local infection
  • 🩸 Thrombus formation or vein inflammation
• Look for severe sepsis/septic shock features:
  • ⬇️ Hypotension
  • ❤️ Tachycardia
  • 🧠 Altered mental status, oliguria, organ dysfunction

🔎 Investigations

• Blood Cultures:
  • Take 2 sets — 1 from the catheter, 1 from peripheral vein
  • Compare growth times & colony counts → confirms CRBSI
• Catheter Tip Culture: Send if catheter is removed.
• Full Blood Count (FBC): 📈 Leukocytosis / neutrophilia.
• Inflammatory Markers: CRP, procalcitonin for severity.
• Imaging: 🖼️ Ultrasound or CT if abscess/thrombophlebitis suspected.

💊 Management

• Suspected Infection:
  • Take swab of site + blood cultures before antibiotics 🧫.
• Empirical Antibiotics:
  • ✅ First-Line: Flucloxacillin 500 mg PO QDS
  • ⚠️ Penicillin allergy: Discuss alternatives with Microbiology
  • 🧬 MRSA suspected: Vancomycin 1 g IV 12-hourly (adjust for renal function)
• Severe Sepsis / Septic Shock 🚨:
  • Immediate Microbiology consult
  • Broad-spectrum IV antibiotics
  • Supportive measures: fluids, oxygen, vasopressors 💉

💡 Key Point: Always reassess: if infection control is not achieved with antibiotics, catheter removal is often essential.