Page 39 - 2022 Risk Basics - Surgical Practice
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SVMIC Risk Basics: Surgical Practice
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 a
pulmonary source, so the surgeon wrote the patient a
prescription for a 10-day course of Levaquin and
discharged her home. Discharge instructions to the patient
did not mention any follow-up for the positive blood
cultures that were obtained from the PICC line during her
hospitalization.
The day after she was discharged, the final results of the
blood cultures and sensitivity report identified resistance
to Levaquin, but sensitivity to methicillin and Vancomycin.
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