Is it safe to place a femoral peripheral nerve catheter in a patient with an active Pseudomonas (bacteria) infection in the ipsilateral leg?

Femoral Peripheral Nerve Catheter Placement in a Patient with Ipsilateral Pseudomonas Infection

It is not safe to place a femoral peripheral nerve catheter in a patient with an active Pseudomonas infection in the ipsilateral leg due to high risk of infection spread and catheter contamination. 1

Risks Associated with Femoral Catheter Placement

• The femoral site is relatively contraindicated for catheter placement due to high risk of contamination at the exit site in the groin area and elevated risk of venous thrombosis 1
• Guidelines specifically state that the use of the femoral vein for parenteral nutrition is relatively contraindicated since it is associated with a high risk of contamination at the exit site in the groin 1
• For patients with suspected catheter-related infections involving femoral catheters, empirical therapy should include coverage for gram-negative bacilli and Candida species, highlighting the recognized infection risk of this anatomical location 1

Pseudomonas Infection Considerations

• Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide with remarkable ability to acquire resistance mechanisms to multiple groups of antimicrobial agents 2
• For episodes of bacteremia due to Pseudomonas species, serious consideration should be given to catheter removal, especially if bacteremia continues despite appropriate antimicrobial therapy 1
• When a patient already has an active Pseudomonas infection, introducing a catheter in the same anatomical region creates a significant risk of spreading the infection or contaminating the catheter 1, 2

Catheter-Related Infection Management

• Long-term catheters should be removed from patients with catheter-related bloodstream infections associated with severe sepsis, suppurative thrombophlebitis, endocarditis, or infections due to Pseudomonas aeruginosa 1
• Empirical antimicrobial therapy for suspected gram-negative catheter-related bloodstream infection should include drugs that are active against P. aeruginosa 1
• In a study of peripheral nerve blocks in young hematology/oncology patients, femoral catheters were associated with the only two cases of infection out of 179 catheters evaluated 3

Alternative Approaches

• If regional anesthesia is necessary, consider:
  • Placing the peripheral nerve catheter at a different anatomical site away from the infection 1
  • Using single-shot peripheral nerve blocks instead of continuous techniques 3
  • Utilizing alternative pain management strategies until the infection is resolved 1

Clinical Implications

• The proximity of an active Pseudomonas infection to the proposed femoral catheter site significantly increases the risk of catheter colonization and subsequent infection 1
• Microbiological testing of devices used in maintaining peripheral venous catheters has shown that 59% of multidrug-resistant bacteria can be isolated from three-way stopcocks, with Pseudomonas aeruginosa being one of the identified pathogens 4
• The risk of spreading the existing infection or introducing additional pathogens outweighs the potential benefits of femoral peripheral nerve catheter placement in this clinical scenario 1

In conclusion, based on established guidelines regarding femoral catheter placement and the presence of an active Pseudomonas infection in the ipsilateral leg, placement of a femoral peripheral nerve catheter should be avoided due to the significant risk of infection spread and complications.