Leakage of septic arthritis after surgery

[wiltmich]

Hi, I have a patient who is s/p drainage and removal of septic knee arthritis. Pt has hx of osteomyelitis and RA. She is on 37 day therapy of abt cefazone (?) via picc. Her right knee is sutured after her surgery about a week ago. The site began draining a serosanguinos fluid. I want to know if this is normal in recovery or an exacerbation of the septic arthritis. She also awoke to a swollen and reddened right wrist joint yesterday to which I applied an ice pack... She had been "rowing a boat" in therapy the day prior... Has a history of RA... Is this a benign flare up or a more serious issue due to her current septic arthritis issue... I'm a brand new nurse... I showed my supervisor he didn't seem worried.. But I am interested and concerned.. Thank you!

[nurseprnRN, BSN, RN]

You can't remove a "septic knee arthritis." Did she have a removal of infected bone (osteomyelitis)/joint/prosthesis? Did she have drainage of an abscess?

New drainage in a postop incision is always worrisome. Watch her for temp, increased WBC (which may be suppressed if she's on some RA drugs-- check), dehiscence (healing can also be impeded by some RA drugs) (nursing diagnoses: risk for infection, risk for delayed surgical recovery) , and other s/s of infection, generally and in the knee. Chart amount of serosanguinous (check your spelling) drainage and see if its amount, color, or character changes, too.

Ask her if the wrist is characteristic of her usual flares, or if it's different. She could seed an infection from an operative site to a distant area. And ask the docs to check when they make rounds.

[been there,done it]

Drainage one week post op is a concern. As far as the wrist... who knows?

Report both findings to the physician. What on earth does your supervisor have to do with this?

[fromtheseaRN, BSN, RN]

For hardware removal in a septic joint, we typically see a copious amount of drainage, at least for the patients at the hospital I work at. With time on the ortho unit you'll start to know what's normal for infected joints and what's not. For the drainage, I would have just let the surgeon know when they rounded that day (or the next). If I wasn't expecting them in within the next day, I'd call and let them know. That being said, I've never had a surgeon say it's abnormal. For a new joint with a lot of drainage or any surgery where infection was not expected or known about, I would call right away.

The wrist pain is concerning, even if it was typical of her RA flares, the docs need to know so they can rule out a spread of infection of adjust her RA meds to treat the flare up.