Infectious Disease

Fever

In the first 24 h postoperative it is reasonable to treat symptomatically. Continue preoperative antibiotics in patients with a pre-existing infection. Postoperative patients receive either:

• cefazolin 1 g i.v. q8 h (total 6 doses) if allergic, then vancomycin or clindamycin to be used:

vancomycin 1 g i.v. q12 h (1 dose if CABG, 2 doses if valve procedure) clindamycin 600 mg i.v. q8 h 6 doses.

If the patient is febrile beyond 24 h, culture urine, blood, sputum and check white blood cell count. If the patient has prosthetic material consider early antibiotic treatment.

Invasive Line Changes

Central lines if not obviously infected prophylactic line changes should be every 7-10 days depending on patient condition and alternate available access.

Arterial lines are changed only if the site is inflamed, infected or in a position that interferes with mobilization.

Selected Readings

1. The ICU Book, Paul Marino, Lea and Febeiger, (1991).

2. Manual of Intensive Care Medicine, edited by Rippe and Csete, Little Brown Spiral, (1983).

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