This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director at the Burns Center at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Today I want to talk about a problem that we occasionally encounter in our ICU in our burn ICU,

and it is potentially fatal if delayed diagnosis or simply missed.

And that is the condition of supperative thromboflobitis.

Now, this is a severe infection, probably is the most severe form of infection, that one can get from a peripheral IV.

There's a lot of emphasis now that we put on things like ventilator, acquired pneumonia,

and central venous catheter infections. But as we're going to show today, that infections of peripheral IVs also have severe, if not sometimes fatal complications.

So it's my hope that when we complete this discussion, that you really are pushing the envelope

as to really try to justify for every single piece of plastic that you're putting in a patient.

Keeping in a peripheral IV in patients just because it's a unit protocol can be potentially hazardous.

Start briefly with the case presentation, and that's our patient,

56-year-old Caucasian gentleman who has a history of hepatitis and COPD,

ends up getting his right leg severely burned pretty much from the waist all the way down to the ankle.

Ends up in the burn intensive care unit undergoes volume resuscitation, undergoes surgical excision,

placement of allographs, which is cadaver skin, not to be confused, with autographs.

And the reason why that was staged because the patient was overall a reasonably poor

physiological specimen and we wanted to get the burns off in a timely fashion and then go back

and autographed him. We had his lines out, went back, eventually placed an autographed in,

and the patient was transferred to the floor. Rounded it on the patient of the morning, he looked

okay, a little bit tachycardic, no fever, interactive. But by the

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