Is your facility using direct intra-articular infusion of antibiotics into septic joints post operatively? We have a physician that wants to insert a Hickman catheter into a knee and infuse Vancomycin BID directly into the intra-articular space. Our nurses have never done this and I am concerned about the possibility of contamination.
Have you done a literature search on this issue? That might provide answers for you. I have never done this but have seen many other strange infusion locations. The VAD is in the septic joint. Yes, the catheter may become colonized with bacteria but what is the alternative for treatment. I would rely upon lit searches for those answers. Remember the catheter is NOT inside the bloodstream in this case. My question would be the use of a tunneled cuffed catheter (aka Hickman). I wonder if anyone has ever used the catheters used to deliver pain management/anesthesia into surgical sites. They act like a soaker hose having multiple locations for the infusing fluid to escape into the tissue. That would seem better to me than a single lumen exit site. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The literature I have found is from both orthopedic and veterinary standpoints. I could not find anything about nurses actually injecting the medications. Our physician had special ordered the Hickman catheters and was in the OR with the patient when they questioned me about this. Apparantly the surgical director did not know his plan when she special ordered the catheters for him because we do not have a physician that places tunneled catheters so we do not stock them in our facility.