What are the culture results? Is your lab doing time to
positivity or colony count comparison? If culture from catheter
becomes 2 hours before the peripheral one, the catheter is the source.
Or if colony count from catheter is at least 5 times more than the
count from peripheral site, the catheter is the source. If neither of
these, the catheter is usually not considered to be the source of the
infection.
There is work being done with EDTA as a catheter flush but not
much has been published with clinical use yet. Dr. Maki is also doing
work with alcohol instillation but again nothing published yet.
Locking with an anti-infective agent has been done to salvage
catheters and there is lots of literature on antibiotic locks. But I
am not aware of an antifungal agent being used for this, although I
have not search the literature for it either. Lynn
At 4:06 PM -0800 11/27/05, Stone, Gloria wrote:
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 HadawayTo: Kimberly Sutters ; [EMAIL PROTECTED] ; [EMAIL PROTECTED]Cc: Kimberly SuttersSent: Saturday, November 19, 2005 1:01 PMSubject: Re: CT Contrast ExtravasationImmediate 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. LynnAt 1:27 PM -0800 11/18/05, Kimberly Sutters wrote:
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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
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Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
