Septic from Venepunture

ChristineN, BSN, RN · Apr 30, 2013

I have seen pts go septic from PIV's that were not changed out but never from just venipuncture.

jadelpn, LPN, EMT-B · Apr 30, 2013

If you stick a patient with anything multiple times, especially a compromised patient, and don't use new needles and sterile technique each and every time, then yes, it is conceivable that this could happen. There are rules about this in a number of facilities. You try 2 times, then someone else needs to. 10 times is very, very, excessive.

Here's a link:

Infection and Inflammation Complications

The U.S. National Library of Medicine explains that a risk of infection is present whenever the skin is broken. Cellulitis is an inflammation or infection in the tissue below the skin surface. It is a rare complication of venipuncture. Cellulitis is more likely to occur when fluids are given than during a blood draw. Phlebitis is an inflammation of a vein, which is another rare complication of the venipuncture procedure. Sepsis--a serious blood infection--is also possible following venipuncture. Sepsis is more likely to occur in patients who have a compromised immune systemThis includes the elderly, patients with immune system disorders and those taking drugs to suppress the immune system. Properly cleaning the site prior to pricking the skin greatly reduces the risk of infection-related complications.

Read more: Venipuncture Complications | LIVESTRONG.COM

kanzi monkey · Apr 30, 2013

If it's really pus, could be pyoderma gangrenosum or sweet syndrome.

Both are interesting diagnoses that are worth your while to look up on uptodate-they're rare, but they pop up sometimes and make people very sick. Primary treatment is immunosuppression, not abx.

If you end up following this pt through hospital course, give us an update!

xoemmylouox, ASN, RN · Apr 30, 2013

Poor patient, that has to hurt. Hopefully she recovers well. I have never heard of sticking someone 10 times, just 2-3 max. Ouch! Perhaps that MA needs re-educating??

BluegrassRN · Apr 30, 2013

Welcome | Jeffrey S. Guy, MD, MSc, MMHC

This guy does podcasts, and he has one dated 2/25/10 titled "That Peripheral IV Can Kill" regarding sepsis from PIV.

All his podcasts are great, at the perfect level for practicing nurses (my level, anyhow).

I am 100% certain I have seen at least one episode of sepsis caused by venipuncture. Immunocompromised guy in the hospital for confusion and possible detox, multiple chronic issues going on, develops sepsis, site unknown. Multiple labs drawn at right AC, that area was swollen, red, hot to touch. When the docs were scratching their heads at conference about his sepsis, I pointed out the venipuncture site. They were both too polite to disagree outright with me, but obviously they did. Cause was officially listed as pneumonia, even though chest xray was clear, pt wasn't requiring any O2, and only had a mild, nonproductive cough (which the pt attributed to allergies). Blood cultures grew out MSSA. PICC line and multiple abx later, right AC looks great, fever and tachycardia are resolved, sepsis is resolved. I still think it was the venipuncture site. It bought him at least 5 additional hospital days and thousands of more dollars in medical care.

HouTx, BSN, MSN, EdD · Apr 30, 2013

Hmm - I wonder why an MA was allowed to perform an invasive procedure (venipuncture) on a a patient with known immuno-compromise? In my state, the patient's complex situation would have automatically made this a "non-delegable" procedure, so it would have had to be done by an RN. In a clinic situation, the physician should have done it if there was no RN available.

On a side note, education for immuno-compromised patients & their families should always include awareness of what type of prep is required for any intervention - so the patient will be able to differentiate & stop anyone who is not following the right procedures. I know that we instruct them to make sure that caregivers wash their hands - while they are watching - wear sterile gloves, wear masks, use skin preps, etc. The patient should be an active participant and maintain control when possible.

dandk1997RN, MSN, RN · Apr 30, 2013

In advance, please forgive me for any typos. My internet is slightly messed up and It's very HARD to type accurately . I'm an LPN so I don't have as broad of scope as an RN
First of all, I would like to let everyone know I work through an agency with MRDD. I accompanied this patient to a lab draw. Within 2 days, her is swollen from the multiple venepuncture sites I guess I never thought this could happen. It's a blood drawl. I didn't complete the draw, per se, but the medical assistant that did apparently stuck him multiple times. He is now in the hospital due to sepsis and is now ATBs via IV.
She is severely immunocomprapized
She was stuck maybe 10 times. After a hot shower, the parent stated that pus was deveping where every injecction site is.
Has anyone ever experienced this bizarre dilemmmia?

Interesting...I was a phleb supervisor for more years than I will admit and never saw this. You say she is immune compromised- can I assume that is her baseline, and not after the venipunctures?

Ten sticks is WAY overboard. 2 per phleb is the max at my hospital, with no more than a couple trying before IV team is called. If they are still unable, the necessity is reconsidered and the absolute last resort is an MS arterial stick.

If the pt was severely immunocompromised, technique would need to be meticulous, if not specifically modified for her safety. Too few people prep the site adequately (and the gauze used afterwards is generally clean, not sterile.)

I think this unfortunate situation should be reviewed by the drawing facility- the least they can do is learn from this poor woman's misfortune.

applewhitern, BSN, RN · May 1, 2013

I agree the problem here sounds like poor prep, or re-sticking with the same needle.

applewhitern, BSN, RN · May 1, 2013

Apparently, in my state, anyone can draw blood on an immunocompromised patient. When I would take my son to the cancer center for his chemo, his labs were always drawn by a lab tech, or an MA, even thru his port. He ended up with an infected port 3 times, however. He learned to be pro-active regarding his health.

jadelpn, LPN, EMT-B · May 1, 2013

In my state, it is not within the scope of an MA or a lab tech who is not certified to do so to draw out of a patient's port or PICC (or IV for that matter). Perhaps time for a policy change. I would call risk managment on this one. Infected ports are horrible, 3 times, inexcusable.