Surgery>>>>>Burns
Question 15#

Fourteen days after admission to the hospital for a 30% partial thickness burn and hemodynamic instability requiring central venous access, a patient develops a spiking temperature curve. On physical examination, the central venous catheter insertion site was red, tender, and warm.

The best treatment for this complication is to:

A. Exchange of central venous catheter over guidewire, culture tip of previous catheter
B. Treat patient with IV antibiotics until blood cultures drawn from catheter are negative
C. Removal of central venous catheter, culture tip, and placement of new catheter on contralateral site
D. Removal of catheter and treat patient with oral antibiotics and pain medication as needed

Correct Answer is C

Comment:

Burn patients often require central venous access for fluid resuscitation and hemodynamic monitoring. Because of the anatomic relation of their burns to commonly used access sites, burn patients may be at higher risk for catheter-related bloodstream infections. The 2009 CDC NHSN report (http://www.cdc.gov/nhsn/dataStat.html) indicates that American burn centers have higher infectious complication rates than any other ICUs. Because burn patients may commonly exhibit leukocytosis with a documented bloodstream infection, practice has been to rewire lines over a guidewire and to culture the catheter tip. However, this may increase the risk of catheterrelated infections in burned patients and a new site should be used if at all possible.