Diagnosis and treatment of cannula-related intravenous sepsis in burn patients

Suppurative thrombophlebitis was identified in 193 (4.2%) of 4,636 burn patients treated during the years 1960-1978. A single vein was involved in 162 patients, while 31 had multiple vein involvement. The distribution and incidence of suppuration in individual veins reflected the frequency of cannulation, with an increase in the use of central vein cannulae, during the last 10 years, paralleled by a rise in central vein suppuration. The infecting organisms reflected the patients' surface flora. Local signs of infection were present in less than half (35%) of the patients and recovery of a positive blood culture in a clinically septic patient was the most frequent clinical presentation prompting exploration of previously cannulated veins. Pathogenetic mechanisms are identified and criteria defined for determining the extent of excision necessary. Ninety veins were excised from 75 patients during the 1969-1978 period, of whom 30 (40%) survived (three other patients with antibiotic treated central vein disease also survived). Treatment failure was attributable to inadequate excision in 12 patients, suppuration within another unexcised vein in eight patients, hematogenous dissemination of infection in five patients in whom the local disease had been eradicated, and other disease in 20 patients. Prophylaxis must emphasize limited duration of cannulation. Timely diagnosis and treatment can effect maximum salvage and reduce the likelihood of systemic dissemination.