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Infection after infusion — Clinical Guidelines

Overview

Infections following infusion therapy can arise due to breaches in sterile technique, device-related issues, or prolonged exposure to certain medications like propofol, potentially leading to complications such as multi-organ dysfunction. 1 4

Diagnosis

Monitor for signs of infection including fever, chills, local site inflammation, and systemic symptoms.

Blood cultures and site-specific cultures (e.g., catheter tips) may be necessary to identify pathogens.

Assess for signs of propofol infusion syndrome (PRIS) in cases involving prolonged propofol use, including metabolic acidosis, cardiovascular collapse, and organ dysfunction. 4

Management

Infection Management: Initiate broad-spectrum antibiotics pending culture results; adjust based on sensitivity data. 1

Propofol-Related Toxicity: Avoid prolonged high-dose propofol infusions; consider alternative sedatives or co-administration strategies cautiously. 2 4

Device Surveillance: Regularly inspect and maintain infusion devices to prevent mechanical failures or contamination. 8

Infection Control Practices: Strict adherence to sterile techniques during infusion procedures to minimize infection risk. 5

Special Populations

Pediatrics: Caution with propofol infusion rates and durations; monitor closely for signs of PRIS. 3

Elderly: Increased susceptibility to complications; vigilant monitoring for both infection and medication-related toxicities is essential. 1

Key Recommendations

Implement stringent infection control protocols during all infusion procedures to reduce infection risk. (Evidence: Strong 1 5)

Limit prolonged high-dose propofol infusions and monitor closely for signs of propofol infusion syndrome, especially in vulnerable populations like pediatric and elderly patients. (Evidence: Moderate 2 4 3)

Regularly assess and maintain infusion devices to prevent mechanical failures that could lead to complications or infections. (Evidence: Moderate 8)

References

1 Mullen KM. Challenges in Having an Infusion Center. Rheumatic diseases clinics of North America 2019. link 2 Ypsilantis P, Politou M, Mikroulis D, Lambropoulou M, Bougioukas I, Theodoridis G et al.. Attenuation of propofol tolerance conferred by remifentanil co-administration does not reduce propofol toxicity in rabbits under prolonged mechanical ventilation. The Journal of surgical research 2011. link 3 Hill M, Peat W, Courtman S. A national survey of propofol infusion use by paediatric anaesthetists in Great Britain and Ireland. Paediatric anaesthesia 2008. link 4 Ypsilantis P, Politou M, Mikroulis D, Pitiakoudis M, Lambropoulou M, Tsigalou C et al.. Organ toxicity and mortality in propofol-sedated rabbits under prolonged mechanical ventilation. Anesthesia and analgesia 2007. link 5 Heisey MR. Test your knowledge: preparing to take the CRNI exam. Pediatrics. Journal of infusion nursing : the official publication of the Infusion Nurses Society 2002. link 6 Kovac AL, Swanson B, Elliott C, Wetzel L. Effect of distance and infusion rate on operation of Medfusion 2010 infusion pump during magnetic resonance imaging. Journal of clinical anesthesia 2002. link00351-3) 7 McCarroll C, McAtamney D, Taylor R. Alteration in flow delivery with antisyphon devices. Anaesthesia 2000. link 8 Brown SL, Morrison AE, Parmentier CM, Woo EK, Vishnuvajjala RL. Infusion pump adverse events: experience from medical device reports. Journal of intravenous nursing : the official publication of the Intravenous Nurses Society 1997. link 9 Palazzo MG, Sabourin MA, Strunin L. Modern infusion pumps: are they accurate?. Canadian Anaesthetists' Society journal 1983. link

Infection after infusion