Peripherally Inserted Central Catheter Nursing Essay

This essay will discuss the implications of infected bone after a hip replacement for 73 year old Mr Andrews. The complications are explained in relation to osteomyelitis; the first paragraph will touch on the pathophysiology. The clinical manifestations of osteomyelitis are spoken in the next section. The reason for PICC insertion, the potential complications and the documentation of Mr Andrew’s wound will be the focus of the following two paragraphs. The essay will concludewith a brief discussion on what needs to be monitored in relation to Haemovac exudate and the need for the medications that are prescribed for Mr Andrews.

Pathophysiology

According to Christensen & Kockrow (2011) osteomyelitis is described as an infection in the bone usually caused by staphylococci bacteria, or in Mr Andrews’ case Enterococcus faecalis. Due to trauma, another infected body part or a fracture; the bacteria can invade the system. These bacteria will enter the bone from the bloodstream infecting the bone tissue. This results in scar tissue which is difficult to treat because the medication will not be able to easily enter the place of need due to the avascularity of scar tissue. The affected bone will become weakened; resulting in an unsteady and unstable gait that will put Mr Andrews at further risk of fractures.the patient will develop an unstable gait and is more prone to fractures. You did not discuss sequestrum or involucrum. ******

Clinical manifestations

Chronic osteomyelitis develops slowly when an infection from somewhere else in the body causes the bone tissue to become infected as well. This may manifest as pain with additional signs such as swelling and rise in temperature. The patient may experience irritability and a gradual reduction in inability to move the limbs freely (Cunha 2012). Christensen & Kockrow (2011) further add that chronic infection may sometimes take years to develop the defining signs and symptoms. The acute form of osteomyelitis is described by Cunha (2012) as an infection that results in signs and symptoms which are noticeable soon after the infection. Acute osteomyelitis manifests in a fever, swelling and pain. Stiffness of the affected area will be experienced immediately which is markedly different from the progression of signs and symptoms of chronic osteomyelitis

Peripherally inserted central catheter

Ugas et al. (2012) explains that PICC’s are tubes which are inserted in the brachial, basilica or cephalic vein in the upper arm. They are used to provide long-term medication, nutritional support, fluids and measuring intravenous pressure. The complications associated with PICC’s are extended upon in Di Giacomo’s (2009) article; the vein can become irritated due to the tube interfering with the natural lining inside the vein causing the blood cells to clot – forming a thrombus. This thrombus can become an embolism, causing a stroke. A thrombus can cause the tube to become occluded, which will then not allow medication or nutritional support to be pushed through. Di Giacomo (2009) describes the most common complication as a complication – blood infections – that can be prevented with the simplest measurements; hand washing and using sterile techniques when dealing with a PICC. A severe complication occurs when the catheter breaks. This can lead to thrombus formation and medication entering cavities outside the vein. The last complication Di Giacomo (2009) touches on is one that is vital but often a forgotten intervention; the changes a patient has to encounter in activities of daily living when living with a PICC at home. Prevention of this complication is done by nursing education and patient compliance.

Dressing change documentation

The information that has to be included in Mr Andrew’s documentation after changing the dressing of his wound is talked about by Gartlan et al. (2010). This article states that the type of wound – is it a chronic or acute wound? – is as important as documenting the size of the wound and which dressing is being used for this particular wound. Other things worth documenting are the products used for cleaning the wound, the method – clean or sterile technique? -, if there is odour coming from the wound and the amount and type of exudate exiting the wound. Schilling-McCann (2002) states that yellow, green or coffee ground coloured exudate has to be reported to the doctor immediately because it may indicate a regressing infection for which more or different medication is needed. The colour of the wound and surrounding tissue has to be documented as this is an indication of how the wound is progressing. Important to document, but in Gartlan et al.’s (2010) research shown to often be left out, is whether or not the patient is experiencing pain at the wound site. This will aid in providing holistic care by offering the patient analgesic medication before changing the dressing.

Observations related to Haemovac exudate collections

Zeitz & McCutcheon (2002) found that vital signs are frequently taken but the physical check of the drainage tube or the check of exudate is not always performed.

This may be due to hospitals not having this check included in their policies as a standard observation on patients with a drain tube. Sussman & Bates-Jensen (2007) indicate the importance of performing regular wound drainage checks. Abnormal smell, the amount, the thickness and colour of the exudate have to be observed. If the exudate is thick and white; it may be an indication of further infection. The colour may also indicate infection of the wound if it shows as yellow or green exudate.

Mr Andrews’ medications

Linezolid (Zyvox) is an antibacterial; given to Mr Andrews to prevent the bacteria from multiplying in his body. The nurse has to monitor Mr Andrews’ sight as a side effect to this medication is blurred vision and discolouration of the visual field (Tiziani 2010).

Enoxaparin (Clexane) is an antithrombotic agent, as mentioned by Giacomo (2009), which allows for the PICC to stay insitu without Mr Andrews experiencing clot formation. Described by Tiziani (2010); the nurse has to make sure that this medication has ceased 10-24 hours before the PICC line is taken out to prevent haemorrhaging.

Docusate sodium (Coloxyl with Senna) is a laxative; this will aid Mr Andrews in maintaining a regular bowel motion whilst in hospital. Some of his medication may cause him to experience constipation; this medication will help prevent constipation. The nurse will have to encourage Mr Andrews to eat foods high in fibre and try exercising as much as possible so that a normal bowel regime will continue upon stopping this medication (Tiziani 2010).

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Tramadol hydrochloride (Tramal) is an opioid analgesic. It is given as pain relieve before the nurse changes Mr Andrews’ wound dressing so he won’t experience too much pain when the dressing is taken off. Galbraith et al. (2004) states that assessing the patient before administering an opioid analgesic is vital; vital signs have to be closely monitored so that interventions can take place if respiratory depression occurs. Constipation is another side effect Mr Andrews can experience.

Paracetamol (Panadol) is an analgesic (Tiziani 2010) which is given to Mr Andrews in combination with Tramal as pain prevention before his dressing change. The nurse will have to ensure that doses are always given with a minimum of four hours apart to prevent liver complications.

Conclusion

Mr Andrews’ hip replacement resulted in an infection of the bone. This infection was noticed by the pain, swelling, redness and discomfort in the hip. A PICC was inserted for long term antibiotics; the nurses will have to ensure adequate education to Mr Andrews so he can maintain caring for himself with a PICC at home. The research done in this essay concludes that documenting a wound dressing change properly is vital to wound healing. Vital to Mr Andrews’ health are the observations on the Haemovac exudate as well; this will enable interventions to be put in place if the infection continues. Mr Andrews’ medications will aid in the healing process as well as preventing the infection from reoccurring; monitoring and education by nurses is essential.