Page 55 - Avoiding Surgical Mishaps Part 1

SVMIC Avoiding Surgical Mishaps: Dissecting the Risks

CASE STUDY

A 43-year-old female who had bariatric surgery on
November 3 presented to the insured’s office 25 days later
with a history of vomiting for four days. The patient was

admitted to the hospital for an endoscopy. The results

showed esophagitis, but no obstruction was present. The
patient was discharged two days later.

One week after the endoscopy, now five weeks after the
bariatric surgery, she was readmitted because of a bowel

obstruction that was identified when she presented with
dehydration, malnutrition, and vomiting. Poor venous

access necessitated the insertion of a PICC line to
administer intravenous fluids and medications. The patient

underwent an uneventful surgery to lyse adhesions that
were causing the obstruction.

During the hospitalization, the patient developed a low-

grade fever with a productive cough, so the surgeon
ordered a breathing treatment, CBC, and blood cultures
to be drawn only from the central line. The blood cultures

returned with gram-positive cocci, confirming the

presence of a PICC line infection. This prompted him to
order the removal of the PICC line and the administration
of an empiric dose of Vancomycin. During the course

of her 12-day admission, her red blood cell count,

hemoglobin, and hematocrit trended downward, but her
highest temperature after the removal of the PICC line
was 99, indicating that the infection was successfully

treated. No additional blood cultures were ordered.

The low-grade fever was thought to originate from
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