RE: question for group new subject

[Stone, Gloria]

Title: Re: CT Contrast Extravasation

Pediatric pt with short gut syndrome, often has positive blood cultures (yeast). Only way to take nutrition is venous. Has gone through multiple central lines in her short life  (4 yrs old).  Just had Picc placed per our radiologist on the 21st. Now Dr. wants to pull picc thinking it is cause of more + cultures even though she had + cultures when it was placed. Today he wanted me to pull Picc, then he decided to do culture from picc and perepheral. ANy ideas out there?  Is there anything that can be placed in the Picc to deal with any contaminant that may have been caused by her + blood cultures? We were never contacted about any of this until after the fact. This poor child has really been through the mill.  She was born with cancer.  Not sure if i'm being very clear, but i'd sure like to save her getting the picc pulled and then getting a hickman, which will also be seeded soon too.  Thanks, gloria stone   Rogue Valley Medical Center -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Nancy Costa Sent: Monday, November 21, 2005 2:28 AM To: Kimberly Sutters; [EMAIL PROTECTED]; [EMAIL PROTECTED]; Lynn Hadaway Cc: Kimberly Sutters Subject: Re: CT Contrast Extravasation Recomendations for treatment of contrast media extravasations from the American College of Radiology are: Elevate affected extremity Apply ice packs at 15-60 minute intervals Call physician if volume > 5ml Consult plastic surgeon if volume:          > 30ml ionic contrast          > 100ml non-ionic contrast Monitor patient for:          Blistering          Ulceration          Altered tissue perfusion, sensation or temperature          Increased or persistent pain American College of Radiology Committee on Drugs and Contrast Media.  Manual on contrast media.  4th Ed. American College of Radiology, Reston, Va. 1998   Hope this helps, Nancy Costa CRNI ----- Original Message ----- From: Lynn Hadaway To: Kimberly Sutters ; [EMAIL PROTECTED] ; [EMAIL PROTECTED] Cc: Kimberly Sutters Sent: Saturday, November 19, 2005 1:01 PM Subject: Re: CT Contrast Extravasation Immediate application of cold for anything that is hypertonic. Vitrase, a brand of hyaluronidase, is available now, but not aware of any published case reports. If severe, I would get a surgery consult as there could be compartment syndrome or necrotic ulcer depending on the volume and type of contrast. Lynn At 1:27 PM -0800 11/18/05, Kimberly Sutters wrote: Content-Type: text/html Content-Transfer-Encoding: 7bit Content-Description: HTML X-NAIMIME-Modified: 1 Dear Colleagues - Are you aware of specific treatment recommendations for the management of a contrast extravasation?  We had a patient with an antecubital PIV who had a significant infiltration during administration of IV contrast with the power injector.   I would appreciate your feedback.   Thanks, Kim     Kimberly A. Sutters, RN, PhD Clinical Nurse Specialist, Surgical Services, Pain Management Children's Hospital Central California 9300 Valley Children's Place (FW07) Madera, CA 93638-8762 (559) 353-5440 (phone) (559) 353-8049 (fax) [EMAIL PROTECTED] Children's Hospital Central California A Great Place to Get Better ------------------------------------------------------------ NOTE: This email and any files transmitted with it are intended solely for the use of the individual or entity to whom they are addressed and may contain confidential, patient health or other legally privileged information. If you have received this email in error please notify the sender by email,delete and destroy this message and its attachments. Any unauthorized review, use, disclosure, or distribution is prohibited. ------------------------------------------------------------ -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861 NOTE: The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. E-mail has the potential to have been altered or corrupted due to transmission or conversion. It may not be appropriate to rely upon this E-mail in the same manner as hardcopy materials bearing the author's original signature or seal. Thank you. Asante® Health System