Not sure I am following your rationale -
alteplase would have no effect on biofilm, just
on fibrin and thrombosis.
Also the original message stated that the child
has had positive cultures of yeast in the past.
If the cultures through the current PICC are also
yeast, antibiotics would not be effective. Has
anyone had experience with using any of the
anti-fungal drugs as a catheter locking solution?
Lynn
At 1:36 PM -0600 11/29/05, Innes, Kim Bourn wrote:
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:
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
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