Oh No! A port infection!

meadow85 · Oct 13, 2008

When was the swab taken? That will determine whether the infection was there before or after your dressing change. The low grade fever the pt. had prior to the dressing change may also answer your question, but then again it could have made them more susceptible to infection. If it did happen during the dressing change (which I doubt from the info you provided) it could have been a number of things. The IV bag, IV tubing, needle, hub, dressing, non-sterile technique - who knows. Just review the policy & procedures manual on your unit. Either way, its over with now.

adria37 · Oct 13, 2008

I would question why they had the port. (cancer, chemotherapy, etc) They probably had a suppressed immune system to begin with and an infection a week later would really be reaching IMHO.

Sonjailana · Oct 13, 2008

Yeah, it is a pt that did have chemo earlier in the week and was getting TPN through the port. This pt was not neutropenic though. I changed the needle and dressing Wed am, the high fever started Thursday.

adria37 · Oct 13, 2008

Most chemotherapy drugs have nadirs at 10-14 days any open area is fair game. I would be interested in what the cultures grew, I bet a staph epidermis. If you used sterile technique then I would not feel bad about it. TPN is a great medium for bacterial growth too.

Iam46yearsold · Oct 13, 2008

When I was much younger and in the Navy, a Port infection was anything we needed to treat after leaving a Port of Call. Things change after 20 plus years

londaj · Oct 14, 2008

hey guys this is londaj speaking from good ole ky, first of all i'm a lpn and work on a med-surge floor in a centrally located hospital that is going thru a major expansion on our floor we give lots of chemo /tpn/lipids due to having lots of cancer pts and even tho we can't iniate blood /chemo or things of that nature we still have to be checked off on picc lines /pac/tldl dressings and still have to monitor that pt ..but anyway you mention that that pt had been running a temp all week or for several days up /down ? then my guess and from previous dealing with ports it could have been the tpn was the tubing changed prior to each bag hung? or did the bag hang for more than 24 hrs ? theses are all policies at our hosp that we monitor even if the bag is half full we still have to change and as for the temp that should have been a sign of some type of infection...be glad to hear some other view :yeah:

Blee O'Myacin, BSN, RN · Oct 14, 2008

I don't think your actions caused this infection - especially given the patient's history, preexisting fever and TPN administration.

Don't throw yourself under the bus over this, especially if the patient and family are looking to blame someone. Make sure your documentation was complete, and if you have to add a late entry to the chart, do so according to facility policy.

Protect yourself and your license. The hospital will be more than happy to let you take the blame above and beyond what's acceptable for "professional accountability". If you did everything according to P&P, then say nothing more on the matter. A cancer patient, even one who is not neutropenic at the time is at risk for infection. And anytime any person has a foreign body implanted, they are at risk for infection.

Blee

nuangel1, BSN, RN · Oct 14, 2008

i agree with blee i don't believe it was you.these pts are setups for infection .chemo port and tpn etc.as long as you followed policy and protocol you are fine.plus be careful pt and hospial would willingly go along with you in saying you caused it .so protect yourself and stop saying you did it.becuase you don't know that.

Sonjailana · Oct 16, 2008

So good news...it was enterococcus!!! And, it's been determined that it was not from the port and much more likely from all the damage to the GI system from mets (fistulas, etc). Thanks for the advice to keep my mouth shut...I'm still a new grad and question my skills. Some vanco cleared it and up this pt is good to go.