Recognizing central venous catheter complications

Question

Click to highlight the findings that require follow-up.

Client with osteomyelitis is receiving outpatient intravenous antibiotic therapy through a right basilic peripherally inserted central catheter (PICC). The transparent semipermeable dressing is clean, dry, and dated three days ago. Catheter external length from the insertion site to the hub measures 4 cm, which matches the baseline insertion record. The nurse observes 2 cm of erythema with yellow purulent drainage around the catheter exit site. Upper arm circumference measured 10 cm above the insertion site is 28 cm, representing a 3.5 cm increase from the baseline measurement of 24.5 cm. When assessing the line, the client reports throbbing pain and burning along the upper arm vein track. The catheter flushes with 10 mL of normal saline with gentle pressure, and brisk blood return is aspirated from the lumen. The client's radial pulse is 72 beats/min and strong in the right arm.

Highlighted phrases are the correct selections.

Answer

2 cm of erythema with yellow purulent drainage around the catheter exit site · representing a 3.5 cm increase from the baseline measurement of 24.5 cm · throbbing pain and burning along the upper arm vein track

Rationale

Purulent discharge and surrounding erythema at a central line entry point signify a localized cutaneous infection that puts the client at risk for central line-associated bloodstream infection. An upper arm circumference increase of 3 cm or greater above baseline strongly indicates extremity edema from an underlying deep vein thrombosis. Throbbing vein track discomfort also suggests localized phlebitis or thrombosis requiring immediate clinical intervention. A clean, intact transparent dressing dated three days ago, an unchanged external length, easy flushing with blood return, and intact distal perfusion are expected findings that do not require escalation.