RE: question for group new subject

Mon, 28 Nov 2005 17:30:46 -0800

Title: Re: CT Contrast Extravasation
You folks are the best.  What a wealth of knowedge, one question and so many good answers.  I'll let you know how it all turns out. Thanks again, gloria stone
-----Original Message-----
From: Sarah Kuykendall [mailto:[EMAIL PROTECTED]
Sent: Monday, November 28, 2005 1:08 PM
To: Stone, Gloria
Cc: [EMAIL PROTECTED]
Subject: Re: question for group new subject

We've had several with short gut, but one especially comes to mind.  She's a
teenager now and has had tpn her whole life.  Believe it or not, she lives a fairly
normal life except when hospitalized - usually for infected central lines.  She's had
so many central lines it's very hard for the doctors to replace them any more. 
 
At one time several years ago she had an infected port and they were
unable to find a spot for a new line.  I'd followed this family since she was born
and even saw the family with home care.  Mom pleaded with me to access the
port hoping they could save it.  For the first time she was afraid her daughter would
die.  I actually accessed it right through the pus and sure enough they treated it
with abx and saved it.   She's had all kinds of central lines in every possible place.
 
Anyway, the point I'm trying to make here is to think long term.  If your patient
survives the cancer she will probably be on tpn a long time.  I do not think a picc
is appropriate.  Do whatever will last and be least likely to be infected.  I know
piccs have a low infection rate, but they are more likely to get phlebitis.  For my
patient a port was best because the parents were very knowledgeable and
trustworthy.  With a port the patient was able to play all day and just have the tpn
at night (I think this was after a surgery which allowed her to absorb a small
amount of food normally).
 
Good luck!  You may have a long aquaintance with this patient and her family.
 
----- Original Message -----
Sent: Sunday, November 27, 2005 4:06 PM
Subject: RE: question for group new subject

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 -----
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:
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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, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
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http://www.hadawayassociates.com
office 770-358-7861


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