Differential Diagnosis for Patient Complaints

The patient is experiencing symptoms of burning, slight swelling, fever, and fatigue at the IV site in the wrist, 2 weeks after placement. Here's a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Phlebitis: This is the most likely diagnosis given the symptoms of burning, swelling, and fever at the IV site. Phlebitis is inflammation of the vein and is a common complication of IV catheter placement, especially if the catheter has been in place for an extended period.

• Other Likely Diagnoses

  • Catheter-Related Bloodstream Infection (CRBSI): Although less common than phlebitis, CRBSI is a possible diagnosis, especially with symptoms of fever and fatigue. The presence of a catheter increases the risk of bloodstream infections.
  • Cellulitis: This is an infection of the skin and subcutaneous tissues and could be a consideration given the swelling and fever. However, it's less directly related to the IV site itself compared to phlebitis or CRBSI.

• Do Not Miss Diagnoses

  • Sepsis: Although less likely, sepsis is a potentially life-threatening condition that could arise from an infected IV site. The presence of fever and fatigue, even without severe symptoms, warrants consideration of sepsis to ensure prompt and appropriate treatment.
  • Endocarditis: In patients with certain risk factors (e.g., pre-existing heart conditions), endocarditis (infection of the heart valves) could be a rare but critical complication of bacteremia originating from an infected IV site.

• Rare Diagnoses

  • Osteomyelitis: This is an infection of the bone and is a rare complication of IV site infections, especially if the infection spreads from the skin and soft tissues to the bone.
  • Septic Thrombophlebitis: This condition involves a bloodstream infection associated with phlebitis and is more severe, potentially leading to sepsis or the formation of septic emboli. It's less common but should be considered in severe cases.