RE: question: CRBSI

[McErlean, Moira]

Betsy:   Sounds to me as if the MD wants the source to be the PICC.   Was the bowel obstruction the reason the patient has a G-tube now? Or is this a long term problem the patient has had? I have seen several MRCP kids – up in their 20s but followed by Pediatrics, who have been admitted with bowel obstructions like this and without surgical intervention, perforate and slowly become septic. The continued abd tenderness with bowel obstruction would push me to examine the bowel again. Any drainage around the G-tube? Is the G-tube to suction and if so is it actually working to aspirate fluid and decompress the stomach?  One patient I saw had a perforation but the g-tube was acting like a stopper and prevented the fluid/blood from below from being aspirated and decompressing the bowel. Keep pushing for the bowel to be further examined. moira From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Betsy Harmon Sent: Wednesday, December 28, 2005 12:22 AM To: [EMAIL PROTECTED] Subject: question: CRBSI   New question for the group.   Had a physician today ask if I had ever heard of a patient having an infected CVC or PICC but was totally asymptomatic?  No erythema, tenderness, drainage, etc at the insertion site of up the extremity for a PICC.  No other symptoms except for a high WBC?    CT of head chest and abd done today on patient Blood cultures pending Sputum cultures growing lots of funky stuff.  No CXR ordered since 10/13/05 UA sent for culture and sensitivity pending Pt has partial Bowel obstruction. Has g-tube, and severe abd tenderness PICC site soft, non-tender complete up inner aspect of arm to axilla when palpated.  No increase in arm circumference, no increase in forarm circumference.  No pain across anterior chest, both lumens flush like a dream.  No erythema, drainage or swelling at insertion site.  Physicians want to pull the PICC for suspected infection source.  Any help to the two questions posed in the first paragraph?  I have asked enough questions about the patient they are waiting until something really indicates the PICC as the source.  We do not do "time to positivity" cultures yet at our facility, the lab is looking into this for me.   Thanks in advance.   Betsy Harmon RN BSN CRNI Vascular Access Team Critical Care Unit Alaska Native Medical Center Anchorage, Alaska [EMAIL PROTECTED]         The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. The University Hospitals Health System and its affiliates disclaim and responsibility for unauthorized disclosure of this information other then the addressee. Federal and Ohio law protect patient medical information disclosed in this email, including psychiatric disorders, (HIV) test results, AIDs-related conditions, alcohol, and/or drug dependence or abuse. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals Health System and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law.