I practice only in the pediatric area and we treat through the line, lock the
line with the antibiotic and we also treat the line with alteplase two times a
week. We do not start the alteplase until 3 - 4 days after starting
antibiotics. There is not any research regarding the use of alteplase for line
infection but our physicians feel that it helps because it gets rid of any
biofilm inside the lumen that bacteria can latch on to easily.
Kim Innes, CRNI
University Healthcare
Columbia, MO
________________________________
From: [EMAIL PROTECTED] on behalf of Nicastro, Margaret
Sent: Tue 11/29/2005 12:03 PM
To: Stone, Gloria; Nancy Costa; Kimberly Sutters; [EMAIL PROTECTED]; [EMAIL
PROTECTED]; Lynn Hadaway
Cc: Kimberly Sutters
Subject: RE: question for group new subject
Perhaps locking the line with an antibiotic that is sensitive to the bacteria
would help. We have had great success when our nursing home patients come in
with positive cultures from the port.
Margaret M Nicastro, CRNI, OCN
Coorordinator IV Therapy/Oncology
Gettysburg Hospital
147 Gettys Street
Gettysburg, PA 17325
Phone: 717-337-4312
Fax: 717-337-4485
________________________________
From: [EMAIL PROTECTED] on behalf of Stone, Gloria
Sent: Sun 11/27/2005 7:06 PM
To: Nancy Costa; Kimberly Sutters; [EMAIL PROTECTED]; [EMAIL PROTECTED]; Lynn
Hadaway
Cc: Kimberly Sutters
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] 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 <mailto:[EMAIL PROTECTED]>
To: Kimberly Sutters <mailto:[EMAIL PROTECTED]> ; [EMAIL
PROTECTED] ; [EMAIL PROTECTED]
Cc: Kimberly Sutters <mailto:[EMAIL PROTECTED]>
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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