A 68 year old man was seen in an emergency department of a hospital for chest discomfort. By the time he reached the hospital, he was asymptomatic with no evidence of any ischaemic changes on ECG. However, he was noted to have a glucometer reading of 20 mmol/L. He is a known diabetic on medications. Thus, he was admitted. Before admission, a branulla/venofix was inserted to his left wrist.
He was admitted to the medical ward and discharged 3 days later. He presented to me yesterday ( 10 days later) with this:
According to the patient, the swelling started immediately after he was admitted but no one bothered to rectify the problem. In fact, before he was discharged, he spiked a fever but he was discharged the same day after removing the branulla. NO antibiotics were given.
He is now having florid cellulitis with pus collection/discharge and ultrasound showed an abscess collection. Despite 2 courses of antibiotics by GP, he did not get better.
The case above is just to illustrate how a simple procedure like this can lead to complications. Since I was a houseman I was trained to look at the branulla site during every round. When I did my housemanship, my consultant was a Haematology trainee and most of her patients were on chemotherapy ( 1 cubicle in the ward was allocated for chemo patients). I was taking care of her patients for almost 3 months as she refused to let me change ward! I had to beg her to let me go to another ward for the last month of my medical posting.
Since haematolgist are very particular about infection, I was trained to look out for any possible hospital acquired infection in all the patients. Since then, I have this habit of looking at the branulla in all my patients. In fact, the nurse in charge will get a earful if she fails to recognise phlebitis and I had always made sure my housemen are also trained to look at it as well.
Unfortunately, many of the younger doctors/nurses nowadays does not seem to be bothered with this. The above complication is what you get when you do not identify early phlebitis and remove the branulla immediately. If the branulla has been removed on the day of the swelling, he would not have developed this abscess. In fact, even antibiotics may not be necessary.
So, I hope the younger doctors will learn why they wanted to become a doctor in the first place: to comfort always, to treat sometimes and to do NO harm. It is your duty to make sure the patient walks out of the hospital better than how he came into the hospital. I use to tell my housemen and medical officers that if a patients walks into the hospital, he should not be going out on a wheelchair or 6ft underground!
For the case above, I am beginning to wonder whether he has MRSA infection as he did not respond to 2 courses of antibiotics by GP!